My symptoms were also atypical...while I got breakthrough heartburn that could be extremely painful (I was on 40mg Protonix AM and PM, plus Ranitidine 300mg at bedtime) my lung involvement was the reason I had the surgery.
I could have lived with the reflux, and the PPIs were protecting my esophagus well. However, while my DeMeester score was just a hair over the "normal range", the reflux I did have was wreaking havoc on my lung health.
I had the surgery done in February 2009. Once my lung infection resolved, my lungs felt 100% better at the 2 and a half month mark.
I may not have had many reflux episodes in a day, but it was obviously enough to cause problems.
Since my surgery I have been able to reduce my steroid inhaler intake to 1/4 of what I took before surgery. Also, I haven't had oral steroids since the time immediately following my surgery.
Also, before surgery when I got gastritis, it would immediately move to my esophagus and I'd have esophagitis as well. During these episodes, I'd consistently lose 20 pounds because I was in so much pain I could eat very little...living on a few spoonfuls of egg custard. Those esophagitis episodes were far worse than my Nissen recovery.
Since my surgery I've had gastritis (I have a reactive stomach)but the poblem was contained there, and my esophagus was spared. What a huge difference.
I would never go back to where I was before surgery, and if I needed to have it again, I would in a heartbeat.
Good luck with your decision!