The manometry sounds like you'd be a great candidate for the surgery. Your LES is
open, which means you're getting reflux, but your swallowing is normal, which means you aren't likely to have swallowing problems post-Nissen, which is one of the problem issues that can occur. The wrap produces more resistance to food as it passes through, so that's why it's important to have a good swallowing reflex.
As far as the surgery goes, I'll say this. My first GI doc was very negative on the surgery. He listed off lots of reasons why it's not that great. He never even tested me for the possibility--even though I was hospitalized over a week for severe GERD that led to uncontrolled asthma. He was not keen on the alternatives, either--Esophyx, etc. because they hadn't been time tested.
I switched GI docs, and the second one did the 24hr PH monitor, and found my GERD to be fairly "mild", so didn't recommend the surgery. He was definitely more positive on the procedure, though. During all this time, my asthma doc and family doc felt that the GERD was causing problems with my lungs.
I suffered for four years. The 40mg Protonix twice a day wasn't doing the job. I still had Maalox and Tums everywhere in my house, and had plenty of breakthrough reflux. My most severe problem was the asthma caused by the refluxing acid inflaming my lungs.
Finally, fast forward four years.
I had suffered with uncontrolled asthma, and had taken so much steroids that I was having adrenal insufficiency, my skin had thinned (my arms look terrible--bruised and skin tears) and I had developed further bone thinning. Still refluxing quite severely at times.
My family doc finally got me to see a surgeon who did an endoscopy and a barium swallow. With the input from my family doc, he declared me a good candidate for surgery.
Not being one to jump into things, I went back to my GI doc with the information from the tests. He gave me the PH monitor test again, and the score was quite a bit higher, but not anything like yours probably is...14, which is considered average...not generally indicating surgery.
At this point, however, he gave more consideration to my asthma symptoms and communication with my asthma and family docs. He then told me, I could either go on treating the reflux with medicine, or give surgery a try.
I went to the surgeon he recommended highly, and discussed it with him. The surgeon's only concern was that my number (14) wasn't very high. He also deferred to my doctors, though.
I finally decided I had to try the surgery. I was tired of not being able to breathe, coughing up mucous constantly, and wheezing. It was not healthy for my lungs or my body. I wish I'd done it years earlier.
I am telling you this story for one reason.
You are the one who ultimately has to decide if the changes that the surgery can cause (no burping--by the way, I was told I wouldn't be able to burp, but I am--no vomiting, etc.) At some point, if your symptoms are bad enough, and you get sick of living that way, no matter what the surgeon/GI doc says, you're the one who has to make the decision.
My son is a lifter, so I know how much that must mean to you. You might research that further, and see if it is absolutely restricted if you have the surgery.
I just hate to see someone be deterred from the surgery by docs who don't really know what it's like to live with the symptoms caused by uncontrolled GERD.
The surgery may not be right for you now...but if your quality of life is negatively affected, it may be right for you at some time in the future.
Good luck, Ben. I hope you don't have to have the surgery, but don't be afraid to have it. It might just be the best thing that ever happened to you...many people here have found it to be a lifesaver!