147 patients (192 hands) with carpal tunnel syndrome were randomized to receive treatment with either endoscopic or open carpal tunnel release and followed up for one year. During the first 3 postoperative months, the endoscopic group was significantly superior to the open group in terms of Carpal Tunnel Syndrome Symptom Severity Scores, Carpal Tunnel Syndrome Functional Status Scores, subjective satisfaction scores, grip strength, pinch strength, and hand dexterity. The open technique group had greater scar tenderness in the first 3 months and greater delay in returning to work. There were no significant differences between groups in terms of surgical cost or complications.