Although mesial temporal lobe epilepsy (MTLE) surgery has become a standard treatment for achieving seizure freedom, it may though be associated with cognitive changes that extend beyond memory and language. We conducted a systematic review of executive functioning following MTLE resective surgery. A thorough search to identify relevant studies that assessed executive functioning pre- and postoperatively (6 months to 1-year follow-up) in patients aged 15 years and over has been undertaken through PubMed, Elsevier, and Google Scholar databases. Seventeen studies met the inclusion criteria. Patients suffering from refractory MTLE present deficits in all the executive domains before surgery. Instead, postoperative executive performance seems to vary. Seizure freedom following MTLE surgery is associated with executive improvement, while the cognitive pathophysiological underpinnings of such an improvement mainly concern the postoperative abolishment of epileptic neural noise propagation from temporolimbic to frontal–executive dependent territories.