Inclusion Criteria:  - Documented hiatal hernia > 5cm on preoperative video esophagram or upper endoscopy  Exclusion Criteria:  Non-English speaking patients Prior antireflux surgery Platelet count less than 100,000 History of platelet dysfunction Antiplatelet therapy up to ten days prior to surgery Corticosteroids use up to one month before surgery Diabetes Active malignancy or treatment for cancer within the last year Pregnancy or active breastfeeding Active smoking