Should fundiplication be done? manometry shows achalasia in 10 yr old grandson. dr recommends cutting muscle along with fundiplication. is that best?

Yes, that is: Generally the operation that would be curative of this condition. If you have any doubts, you should seek a second surgical opinion.

Maybe: The myotomy or cutting the muscle is the most important part of the procedure. It's often helpful to do a 24 hour ph study to see if there's reflux. Only 10% of patients with achalasia have reflux. They absolutely need the fundoplication. If the operation is done laparoscopically, you must do a fundoplication, regardless. It's a technical issue. If it's done through the chest, no fundoplication.

You doc is right: Cutting the esophageal sphincter muscle, which is the primary and most definitive treatment for achalasia, usually causes reflux so a fundiplication should be done to prevent reflux. This is especially important in a 10 year old who, hopefully, has a lifetime to live with the adverse consequences of reflux. You have gotten good advice!