Objective: To analyse long-term employment outcomes in a population-based cohort of adults who underwent epilepsy surgery in childhood or adolescence and to compare the results to general population reference data. Methods: Prospective data on epilepsy surgery procedures performed on patients <19 years of age between 1995 and 2012 were extracted from the Swedish National Epilepsy Surgery Register. Five-, 10-, 15- and 20-year follow-up data were analysed. Patients aged ≥19 years at follow-up were eligible for inclusion. Educational attainment and employment status were analysed in relation to seizure outcome. Education and employment outcomes of seizure-free patients with a preoperative IQ of ≥70 were compared to general population reference data. Results: A total of 203 patients were included. The mean age at surgery was 13.6 years and 66% had IQ≥70. Of these, a majority had attained at least high school education five years after surgery. Employment rates were 44%, 69%, 71% and 77% at the 5-, 10-, 15- and 20-year follow-ups, respectively. Seizure-free patients were significantly more likely to work full-time. Educational attainment and rates of full-time employment of seizure-free patients were similar to the general population. A majority of patients with IQ<70 had attended special education and were reliant on social benefits. Conclusion: Long-term overall employment rates were higher compared to most previous studies on surgery in adults. Seizure-free patients with a preoperative IQ≥70 showed rates of full-time employment similar to the general population. Further research is needed to determine whether this also applies for occupational complexity and wages.