Objective: To evaluate the surgical outcomes of treating severe and very severe carpal tunnel syndrome (CTS) in patients with gout. Methods: This retrospective study involved the surgical release of the carpal tunnel and decompression of the median nerve in 40 patients (45 hands) diagnosed with severe and very severe CTS in the context of gout at the Huu Nghi Viet Tiep Hospital from January 2020 to June 2022. Symptom severity and hand function were assessed in all patients by using the Boston scoring system and clinical tests. Results: After 24 months post-surgery, the Boston score decreased significantly from 4.63 points to 3.2 points, with a noticeable reduction in numbness symptoms. However, recovery from muscle atrophy was slow. Conclusion: Surgical treatment of severe and very severe CTS in patients with gout contributed to symptom improvement and enhanced hand function, thereby enhancing the overall quality of life and daily activities.