Diaphragmatic herniation is a common medical problem characterized by protrusion of the abdominal viscera directly through (95% of cases), or adjacent to (5% of cases), the esophageal hiatus. Individuals suffering from these so-called hiatal and paraesophageal hernias experience symptoms such as regurgitation, heartburn, early satiety, and in extreme cases, respiratory compromise or visceral strangulation and ischemia. Unless the hernia is small, these symptoms are generally refractory to medical management and require surgical correction, with approximately 40,000 antireflux surgeries being performed each year in the United States. The hernia repair procedure, which may be performed in either a laparoscopic or open fashion, involves reduction of the intrathoracic viscera back into the abdominal cavity and closure of the diaphragmatic defect. Generally, this closure of the hernia can be accomplished primarily, using nonabsorbable suture to approximate the edges of the defect. Unfortunately, the recurrence rate for this type of repair is unacceptably high and ranges from 10-40%. Furthermore, in the instance of a particularly large hernia, the edges of the defect may be too far apart to be primarily brought together, necessitating the use of other strategies such as relaxing incisions or patches to bridge the gap. Although the precise recurrence rates of these complex repairs is not clear, it is expected that they are even higher that for those diaphragmatic hernias that can be closed primarily.