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Objective: To assess the long-term outcomes of epilepsy surgery between 1995-2015 in South Wales, UK, linking case note review, postal questionnaire and routinely-collected healthcare data. Method:We identified patients from a departmental database and collected outcome data from patient case notes, a postal questionnaire and the QOLIE-31-P and linked with Welsh routinely-collected data in the Secure Anonymised Information Linkage (SAIL) databank.Results: 57 patients were included. Median age at surgery was 34 years (11-70); median 24 years (2-56) after onset of habitual seizures. Median follow-up was 7 years (2-19). 28 (49%) patients were free from disabling seizures (Engel Class 1), 9 (16%) experienced rare disabling seizures (Class 2), 13 (23%) had worthwhile improvements (Class 3) and 7 (12%) no improvement (Class 4). There was a 30% mean reduction in total anti-epileptic drug (AED) load at five years post-surgery. 38 (66.7%) patients experienced tonic-clonic seizures pre-surgery verses 8 (14%) at last review. Seizure-free patients self-reported a greater overall quality-of-life (QOLIE-31-P) when compared to those not achieving seizure freedom.Seizure-free individuals scored a mean of 67.6/100 (100 is best), whereas those with continuing seizures scored 46.0/100 (p<0.006). There was a significant decrease in the median rate of hospital admissions for any cause after epilepsy surgery (9.8 days per 1000 patient days before surgery compared with 3.9 after p<0.005).Significance: Epilepsy surgery was associated with significant improvements in seizures, a reduced AED load and an improved quality-of-life that closely correlated with seizure outcomes and reduced hospital admission rates following surgery. Despite this there was a long delay from onset of habitual seizures to surgery. The importance of long-term follow-up is emphasized in terms of evolving medical needs and health and social care outcomes.