Aims: During the last two decades, new treatment methods have been developed for the surgical removal of second branchial cysts which result in less visible scars. The aim of this systematic review is to assess which surgical technique for second branchial arch cyst removal results in the lowest complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed literature in the Cochrane, PubMed and EMBASE databases (search date: 1975 to December 23th, 2019) to identify studies comparing surgical outcomes of second branchial arch cyst removal. Authors appraised selected studies on directness of evidence and risk of bias. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Out of the 2101 retrieved articles, four articles were included in the current review including a total of 140 operated cysts. Only two studies included pre-operatively infected cysts. Follow up ranged from 3 to 24 months. Complication rates ranged between 0 to 27.3% (conventional: [0-10.4%]; endoscopic/retro auricular: [0-27.3%]). None of the patients presented with postoperative recurrence. Significantly higher scar satisfaction was found in adult patients who underwent endoscopic or retro-auricular hairline incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up using either conventional surgery or endoscopic/retro auricular techniques. Although more (temporary) complications occur using endoscopic and retro-auricular techniques, patients report a significantly higher scar satisfaction 3 to 6 months after surgery in comparison to the conventional technique. Future studies are needed to support these findings.