In this BoardsCast episode, we continue Tobias Chapter 90 – Esophagus by confronting one of the deadliest assumptions in soft-tissue surgery:
“If it’s perforated, just close it.”

For the esophagus, that logic is often fatal.
 Because of its segmental blood supply, lack of serosa, constant motion, high intraluminal pressure, and heavy contamination, primary closure is frequently the worst possible choice — and in many cases, it guarantees dehiscence.

This episode rewrites the mental model of esophageal repair by explaining when NOT to close, when alternative strategies outperform primary suturing, and what the boards want you to recognize instantly.

You’ll learn:

• Why primary closure fails in the esophagus far more than in any other GI organ
• How ischemia, tension, pressure, and contamination doom repairs
• When “source control first, closure second” is the correct surgical sequence
• Why diversion, stenting, bypassing, or allowing controlled fistula formation may be safer
• The high-risk locations where closure never holds
• Why thoracic vs cervical esophageal injuries must be managed differently
• Board-relevant presentation patterns for leaks, mediastinitis & fatal dehiscence

This episode teaches you how to stop thinking “repair the hole” and start thinking “preserve the patient.”

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