I definitely understand your frustration about the fact that you're getting a little reflux upon lying down. From what I've heard, though, surgeons do not attempt to achieve zero reflux. Rather, their goal is "normal" reflux levels (<14 DeMeester). The problem is that if zero reflux were achieved, the wrap would be so tight that you wouldn't be able to eat, which is unacceptable. You wouldn't want that situation, believe me. Several have posted here with wraps that are too tight, and are requiring dilation. A tight wrap creates other difficult problems as well, such as inability to swallow and the discomfort of bloating.
Pretty much anything you read about Nissen surgery makes note that it is not a guarantee that you won't need PPIs afterward. Here is a case in point:
Here is some copied info from this website:
For some people, surgery can improve GERD symptoms and lower the amount of medicine they need.
What does the research say about surgery?
- Fundoplication surgery works as well as only taking medicine to keep you from getting acid reflux and heartburn. However, you may still need medicine after surgery to control your symptoms.
While we'd always love to never have reflux again after our surgery, it is really only meant to reduce reflux to a "normal" level. That's the reason my PCP and asthma doc want me to continue taking a PPI at dinnertime (I used to take 40mg AM and PM and 300mg Ranitidine at bedtime, so this was a big reduction for me). I also continued to sleep with the head of my bed elevated. In my case it's important to keep even a tiny amount of reflux out of my very reactive lungs. I rarely get reflux, but in happens every once in a while.
The reason that my GI doc dragged his feet for so long when my PCP and asthma docs were certain that my reflux was making my asthma uncontrollable, was just this situation. My DeMeester score was very low each time I had my 24hr PH monitor...at one time it was only 4. During that time, my lungs were terrible, but my GI doc assured me that the reflux wasn't creating the problem.
After 5 years of struggling, my PCP finally referred me to a surgeon himself, who did testing and on the recommendation of my PCP told me I'd be a good candidate for surgery. At that point I went back to my GI doc and had another 24hr PH monitor. My DeMeester score at that time was something like 14.8...very borderline. But because my PCP had taken that extreme step of referring me to a surgeon, my GI doc finally relented and sent me to a surgeon. The rest is history.
You see, since reflux can not be eliminated, my GI doc was concerned that my low DeMeester score wouldn't be improved, and my lungs would not respond. Apparently the few reflux episodes I was getting were bad enough that they reached my lungs, because since my surgery, they've been 100% better.
I share this to emphasize the expectation that a Nissen will not eliminate all reflux. No GI doc or surgeon has that expectation.
Since you're getting some reflux upon laying down, it certainly makes sense to elevate the head of your bed to ensure that it stays in your stomach and doesn't sneak out while you're sleeping. I don't know if you're getting any symptoms, but it makes sense that if you end up wanting to take a PPI for symptoms, before dinner would be the time to do it, since your reflux is limited to lying down.
Try not to let this get you down. If you can look at it realistically, and understand that it does not indicate a failure of your wrap. It's a normal situation, and nothing to be concerned about.
Words of wisdom by Eckhart Tolle:
"Whatever you fight, you strengthen, and what you resist, persists.”
“Worry pretends to be necessary but serves no useful purpose”
“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”