Obesity is an escalating health problem that has been increasingly associated with surgical complications. In general, open surgical techniques worsen these complications, because they are more tissue-destructive and associated with a relatively long recovery period. Minimally invasive techniques, such as endoscopic spine surgery, appear to be good substitutes, because they reduce tissue iatrogenic injury and hasten recovery. However, the effect of obesity on the performance of endoscopic spine surgery remains uncertain. This metaanalysis was designed to evaluate the safety and efficacy of endoscopic spine surgery in patients with obesity compared with those without obesity. This study adhered to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. We conducted a thorough search using PubMed, Scopus, and Virtual Health Library. Methodological quality was assessed using the MINORS (Methodological Index for Non-randomized Studies) criteria. Mean differences (MD) and standardized mean differences with 95% confidence intervals (CI) were calculated. Statistical analyses were conducted using Review manager ver. 5.4.1. Seven studies involving 659 participants were analyzed. The obese and nonobese groups had no significant differences in operative time (MD, 9.86 minutes; 95% CI, −4.93 to 24.65); Visual Analog Scale (VAS) scores for back pain at 3 months (MD, 0.26; 95% CI, −0.11 to 0.63), 6 months (MD, 0.26; 95% CI, −0.05 to 0.56), and 12 months (MD, −0.54; 95% CI, −1.70 to 0.62); VAS leg pain scores at 3 months (MD, 0.17; 95% CI, −0.06 to 0.41), 6 months (MD, 0.23; 95% CI, −0.13 to 0.59), and 12 months (MD, 0.18; 95% CI, −0.10 to 0.45); Oswestry Disability Index scores at 3 months (MD, 1.02; 95% CI, −0.14 to 2.18) and 12 months (MD, 0.10; 95% CI, −1.14 to 1.33); and reherniation rate (odds ratio, 1.35; 95% CI, 0.73 to 2.49). Endoscopic surgery demonstrated no significant differences in outcomes between obese and nonobese patients and was safe and effective for this patient population.