What if none of the medicines work? 

In very severe cases where no medicines seem to work, and there is the danger of the acid and fluids entering the lungs then the doctor might prescribe surgery for GERD. A procedure commonly known as anti-reflux surgery (or fundoplication) is performed on the esophagus and stomach to prevent the reflux from occurring. The procedure is especially useful for those GERD patients who have also developed a hiatal hernia. The surgeon pulls down the herniated sac and stitches it below the diaphragm. Then the opening in the diaphragm through which the esophagus passes is also tightened. The surgeon will also make an artificial LES by wrapping the upper part of the stomach, next to the opening from where the esophagus enters the stomach, around the lower esophagus. To perform this surgery the doctor may make an incision in the abdomen or make small puncture sites in the abdomen (laproscopy) through which he will pass a small viewing device and surgical instruments. Laproscopy minises the blood loss from surgery and the patient recovers mush faster. 

A new line of treatment for GERD is endoscopy. This does not require any hostpitalisation or even surgical procedures. There are many ways in which endoscopy is being performed for GERD patients, the most common is where the doctor will stitch the LES, which tightens the valve preventing acid reflux. But since this is a very recent development, it is still not very widely prevalent. 
GERD surgery is usually very effective and its results can be felt for upto 10 years. However many patients may still continue taking anti reflux drugs, especially if they have developed other complications along with GERD.