More Problems

I have a friend who had GERD and underwent a Nissen Fundoplication. Prior to the surgery they smoked, and continue to do so. I've read that smoking is very bad for people with GERD because it relaxes the LES. This surgery however is suppose to strengthen that sphincter.

My friend is experiencing a few problems and I'm wondering if it's because they continue to smoke.

They are beginning to occasionally get heart burn again. This problem I see relating to the continuance of smoking, but need a professional opinion.

They also have gas bloat syndrome, which according to research is normal for about 4 weeks, but this procedure was done about a year ago. I read something about gastric dismotility and delayed gastric emptying (I'm thinking those are the same thing?), and they seem to be dealing with that as well. They experience a lot of pain after eating meals. Laying down seems to help a little. They complain that physical activity after eating prolongs the pain and somehow seems to prevent digestion.
Could smoking, in some way, be the cause of those issues as well?

An article I read said that some patients might need to have a pyloroplasty along with this procedure. This may solve the latter problems without discontinuing smoking.

I'm afraid that if they don't stop smoking, the entire procedure would have been in vain because by smoking, they seem to be preventing the LES from gaining the strength it's suppose to.

I'm afraid to tell them that quitting smoking is necessary for this procedure to do it's job because I would assume that they should already have this knowledge. I'm pretty sure they were addicted to second hand smoke before they were addicted to cigarettes, so quitting would be incredibly difficult for them, especially considering that everyone surrounding them smokes as well.