Background: Carpal tunnel syndrome (CTS) is a nerve entrapment disorder characterized by pain, paraesthesia and hand muscle wasting. Appropriate treatment used to avoid permanent disability development. Conservative treatment could be enough, although some patients need surgery. Surgical treatment includes open or endoscopic technique. Objectives: This study was aimed to compare the endoscopic carpal tunnel release (CTR) results of open CTR in patients having idiopathic Carpal tunnel syndrome (CTS). Patients and Methods: This study carried out in the Department of Orthopedic Surgery in the Faculty of Medicine, Zagazig University Hospital (Egypt) and Misurata Medical Centre (Libya) on 48 patients subjected to surgical and endoscopic approach (24 Cases for each). Results: Endoscopic group was significantly better than open group regard Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). There was no statistical significant difference in the studied groups regard any score and both groups were nearly matched both group were significantly improved from pre to early and also late post operative. There was no statistical significant difference between studied groups regarding general distribution of complication between groups but infection and pillar pain was significantly higher in open but recurrence significantly higher in endoscopic group. Conclusions: Short-term outcomes were better in the endoscopic method according to the absence of scar tenderness and the comparable results at six months in the surgical and endoscopic approach. There were no statistical significant difference regarding complications in the carpal tunnel release by the two methods in the studied groups.