In this BoardsCast episode, we begin Tobias Chapter 91 – Stomach by dismantling one of the most common (and dangerous) mental models in soft-tissue surgery:

•  The stomach is not a bag.

 It is a reservoir, a grinder, a mixing engine, and a precision gatekeeper — and when surgeons treat it like a passive container instead of a physiological machine, patients fail despite perfect closures.

This episode reframes gastric surgery from “fix the hole” to “protect the physiology.”
We explore how surgeons can break stomach function even when the incision is flawless and the post-op contrast study looks perfect.

You’ll learn:

• Why the stomach must be understood in functional zones — reservoir vs grinder vs gatekeeper
• How receptive relaxation prevents reflux and protects the esophagus
• Why the antrum’s retropulsion mechanism is essential for digestion
• How inverting suture patterns at the pylorus cause iatrogenic obstruction
• Why the stomach’s acidic environment destroys PDS long before the tissue has healed
• The 3 pyloroplasty techniques — and how to choose the right one
• How postoperative gastric ileus mimics obstruction and leads to unnecessary reoperations
• The five predictable surgical failures caused by “bag thinking”

If you judge gastric surgery by absence of leaks, you’ll miss the real failure: loss of function.

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