Background and Aims Hilar cholangiocarcinoma (HCCA) is a prevalent malignant biliary tumor encountered in clinical practice with a unique anatomical location, high invasiveness, and great surgical difficulty. In recent years, with the development of laparoscopic technology and minimally invasive surgical techniques, laparoscopic radical resection of HCCA has been performed in some large hepatobiliary medical centers. This approach has advantages over traditional open radical resection of HCCA, but there is still some controversy regarding the choice between these surgical methods. This study was conducted to compare the efficacy and safety of laparoscopic versus open radical resection of HCCA through a Meta-analysis, providing evidence-based medical references for clinical practice.Methods The clinical studies comparing laparoscopic and open radical resection of HCCA were collected by searching multiple domestic and international databases. The search period spanned from the inception of each database to August 31, 2023. After screening the literature based on inclusion and exclusion criteria, data extraction, and quality assessment of the included studies, a meta-analysis was performed using RevMan 5.3 software.Results A total of 20 studies were included, involving 1 036 patients, of which 457 underwent laparoscopic radical resection of HCCA (laparoscopic group), and 579 underwent open radical resection of HCCA (open group). The meta-analysis results indicated that, in terms of primary outcomes, the laparoscopic group had a higher number of lymph nodes dissected (MD=0.61, 95% CI = 0.11-1.12, P<0.05) and a higher R₀ resection rate (OR=2.47, 95% CI=1.47-4.14, P<0.05), but had no statistically significant differences in the overall postoperative complication rate or the 1-, 2-, and 3-year survival rates compared with the open group (all P>0.05). For secondary outcomes, the laparoscopic group had a longer operative time (MD=51.39, 95% CI=44.78-57.99, P<0.05), less intraoperative blood loss (MD=-75.29, 95% CI=-92.46--58.12, P<0.05), and shorter incision length (MD=-10.25, 95% CI=-19.12--1.38, P<0.05), as well as shorter length of postoperative hospital stay, time to postoperative food intake, and time to postoperative ambulation compared with the open group (all P<0.05).Conclusion The current evidence suggests that laparoscopic radical resection of HCCA is safe and effective, with an increased number of lymph nodes dissected, a higher R₀ resection rate, and less trauma. However, due to the limitations of the studies, more high-quality research is needed to validate these conclusions further.