Purpose: To assess the seizure‐freedom rates and self‐perceived psychosocial changes associated with the long‐term outcome of epilepsy surgery in patients with refractory medial temporal lobe epilepsy associated with hippocampal sclerosis. Methods: A standard questionnaire was given to 183 patients who underwent surgery between 1988 and 2004, and 110 were completed. Results: The mean duration of follow‐up after surgery was 7 years, with a maximum of 17 years. The probability that patients were seizure‐free after surgery was dependent on the definition of the seizure freedom. For the patients who were seizure‐free since surgery (Engel's class Ia), the probability was 97.6% at 1 year after surgery, 85.2% at 2 years after surgery, 59.5% at 5 years after surgery, and 42.6% at 10 years after surgery. For the patients who still experienced rare disabling seizures after surgery but were seizure‐free at least 1 year before the time of assessment, the probability was of 97.6% at 1 year after surgery, 95% at 2 years after surgery, 82.8% at 5 years after surgery, and 71.1% at 10 years after surgery. The psychosocial long‐term outcome, as measured by indices of driving, employment, familial and social relationships, and marital status, was similar to the psychosocial short‐term outcome. It did not depend on seizure freedom or on follow‐up time interval and was not influenced statistically by seizure frequency in cases of persisting seizures. Most but not all patients noticed a substantial overall improvement in their psychosocial condition; 48% drove (increased by 7%), 47% improved (14% worsened) in their employment status, and 68% improved (5% worsened) in their familial and social relationships. Overall, 91% of patients were satisfied with the surgery, and 92% did not regret their decision. Conclusions: The results of this study suggest that temporal lobe surgery has real long‐term benefits. Two specific conclusions emerge: (a) the long‐term rates of freedom from seizure depend on how seizure freedom is defined, and (b) the psychosocial long‐term outcome does not change dramatically over years and does not depend on seizure freedom.