Ayazi S, et al. - Researchers examined how hiatal hernia (HH) status influence the outcome of magnetic sphincter augmentation (MSA), an effective treatment for patients with gastroesophageal reflux disease. In addition, they sought to report the rate of HH recurrence after MSA. For this retrospective review, they obtained data of 350 patients [60% female, mean age: 53.5 (13.8)] who underwent MSA. Among these cases, no HH was evident in 65 (18.6%) cases, small HH (< 3 cm) was reported in 205 (58.6%) cases, large HH (≥ 3 cm) was reported in 58 (16.6%) cases and paraesophageal hernia (PEH) was noted in 22 (6.2%) cases. In this work, the largest series of MSA implantation is reported. Outcomes illustrate that the presence or size of HH does not influence the excellent outcomes and high degree of satisfaction after MSA. Despite higher hernia recurrence rates, large HH and PEH patients exhibit similar rates of postoperative endoscopic intervention, and device removal when compared to those with no or small HH. They recommend abandoning the minimal dissection approach to MSA.