In 2,388 patients undergoing fundoplication or magnetic sphincter augmentation for reflux disease, body mass index of 35 or higher did not worsen symptom relief, medication independence, or five-year durability.

• Obese patients had larger hiatal hernias and more severe reflux before surgery.
• At 1 year, satisfaction was 81.6% versus 83.3%, and proton-pump inhibitor independence was 85.1% versus 85.5%; results remained similar at 3 years.
• Five-year anatomic integrity and revision rates were also comparable: 75.8% versus 78.2% and 4.5% versus 5.3%.

For magnetic sphincter augmentation, acid exposure normalized less often in obese patients (48.1% versus 71.0%). Body mass index alone should not exclude patients from antireflux surgery.