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To analyse the long-term outcome of patients who underwent temporal lobe resection for intractable temporal lobe epilepsy at Auckland Hospital.We performed a retrospective analysis of 176 patients who underwent temporal lobe resection at Auckland Hospital, New Zealand between 1987 and 2007. We had at least 1 year of follow-up on 174 patients.Overall 98/174 (56%) individuals were seizure-free at 1 year (Engel Class 1) with a marked improvement in quality of life. A further 61/174 (35%) had rare seizures or had significant improvement in seizure frequency (Engel Classes II or III). At last follow up (mean 4.3 years) 95/174 (55%) were seizure-free (Engel Class 1). Hippocampal sclerosis was the pathological finding in 129 patients. Surgical complications included 2 (1.1%) deaths, while 6 (3.4%) patients had symptomatic visual field defects, and 8 (4.5%) had other permanent neurological problems. A further 18 (10.3%) patients had temporary complications including infection, pulmonary embolus, and aseptic meningitis. New psychological symptoms occurred during the first year after surgery in 52% of 114 patients for whom we had detailed psychiatric assessments.Temporal lobe resection is effective in controlling medically intractable seizures, but there are potentially serious complications that need to be considered when counselling patients for such a procedure.