LPR is a unique form of reflux in that it can take very little reflux to create very big problems. Atypical symptoms are more difficult to cure via Nissen surgery, and the success rates are not as high as "typical" GERD.
Here is a quote from a study:
Performing a Nissen fundoplication is the primary
surgical option pursued if medical management does not alleviate LPR in
patients. Entailing the encirclement of
the esophagus with the gastric fundus, fundoplication carries a 90% ten-year
success rate in those experiencing GERD.
Available literature suggests a Nissen fundoplication may improve
LPR-related signs and symptoms in 73-86%, although it should be noted that
there appears to be a poorer response to surgery in those who have failed four
months of medical therapy--and yet, surgery is an option offered to those who
do not exhibit significant improvement under such conservative management.
As you can see, the success rate is lower for LPR patients. That said, it can be a good option for improving symptoms in some patients.
I personally don't think that anyone who is controlling their symptoms well with PPIs should consider the surgery for LPR. The likelihood that you will never need PPIs is definitely not a guarantee.
My most problematic LPR symptoms was severe asthma that could not be controlled, even with high doses of steroids. I was even hospitalized when a bout of gastritis increased my reflux.
I really didn't have a choice. I had to have the surgery. I wasn't sure whether or not it would cure my lungs, but nothing else was working, and I had to at least try it. That way, if it didn't do the trick, we could rule reflux out as the cause.
I had been on 40mg of Protonix before breakfast and dinner, as well as 300mg of Zantac to augment acid suppression. Even with all of that medication, my lungs continued to be dangerously unhealthy.
I had the surgery in February 2009 and it took two and a half months, but my lungs responded extremely well.
My PCP and asthma docs both want me to continue on PPIs (just 40mg before bed) simply because LPR patients are hypersensitive to any reflux at all. The Nissen surgery does not ensure that absolutely no reflux will ever escape your stomach. It improves the likelihood, but in order to be absolutely sure, the wrap would have to be so tight that food wouldn't be able to go through.
People with typical GERD aren't sensitive to "normal" amounts of reflux (all people get some reflux), so when the loose wrap allows a little reflux, it doesn't bother them. Those of us with LPR are far more sensitive, and that's why the success rate is lower.
I also continue to keep the head of my bed elevated. I do these things to help ensure that my lungs will remain healthy.
For me, the Nissen surgery was literally a lifesaver.
I am thankful I had it, and would have a redo happily. I do not ever want to go back to the condition I was in before the surgery.
I wish you luck in finding an answer to your unique issues.
It's not fun to have GERD, and LPR is in many ways much more frustrating, as there is not a clearcut fix.
Hang in there...we just have to make the best of whatever situation we're in.