Been offered Fundoplication, but are my symptoms bad enough?

I am a 36 year old male, who was diagnosed with a 2-3cm Hiatus Hernia at the end of 2015 after a gastroscopy. The lead up to this was a year of acid reflux symptoms, and me taking 20mg of omeprazole which worked initially, but then stopped working.

I was told to immediately start taking 40mg of esomeprazole, which worked well for around 6-12 months, but then I kept having acid reflux symptoms - although I admit I was not adjusting my diet at all at this point. Along with my 40mg of esomeprazole in the morning I started taking 150-300mg of ranitidine at night, I reduced all the main acid producing foods from my diet (alcohol, caffeinated drinks, fizzy drinks, most kinds of fruit, onions, tomatoes etc), and stopped eating after 6pm. I also took gaviscon when my symptoms were not controlled by the pills.

I have good and bad periods, but during a bad period of high acid reflux I went to my doctor, and he agreed to arrange another gastroscopy. This was the middle of 2017, and the results were - my hiatus hernia had grown to 5cm, I had polyps in my stomach (a common side effect of PPIs I now realise), and a schatzki ring (narrowing) in my lower oesophagus. I then had a 24h Ph study and manometry test, which showed I did have acid reflux although not excessively so, and I had a slightly weak swallow. I was told I could now speak to a surgeon about fundoplication if I wanted to, and I have had my first meeting him where he explained the surgery and has now given me a couple of months to think things over and decide what to do. He said because of me slightly weak swallow he would only do a partial wrap as otherwise there might be a risk that I would struggle to swallow anything. This makes me worried that the procedure will be less effective at stopping the reflux?

I have read many many things about the fundoplication surgery, most of which scare the hell out of me. It is clearly major surgery which causes life-changing side effects, and is also not guaranteed to actually solve the problem! However, looking at the stats it does seem than long term most people are happy with the results, despite the adjustments you have to make to eating and the many other side effects. It just seems very much like a decision not to take lightly.

I have good days and weeks where I don't get much acidity and pain, should I even be considering this surgery? Is it really only for people who are in awful pain and discomfort all the time? If there is some chance of mostly controlling my symptoms with medication, should surgery be the last thing I should be considering?

However the other worry is the potential long term side effects of PPI medication. I've read about the potential of brittle bones, and the reduced absorption of certain vitamins and minerals. I was also very worried by the recent release (end of 2017) of a study done in Hong Kong, which potentially saw a link between long term PPI use and Stomach Cancer - although there are a lot of qualifications to their results, it is still worrying.

Should I take the risk of surgery and all the likely long term side effects, and potentially make my life much worse than it is right now, just get off the PPI medication? Or should I stick to the medication if it is mostly working for me? I’m still mid 30s, so the thought of being on medication for another 30-40 years doesn't sound great. I'm just really worried that if I have the operation I'll end up in a worse position that I am now....although potentially it might save me from any PPI side effects in the distant future...but nothing is every guaranteed is it...

I would love to hear from people who have had the fundoplication operation, and know what their life is like now. Although I am aware that you are more likely to be posting on internet forums when you have a problem!

Thanks for reading.

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