In this BoardsCast episode, we finish Tobias Chapter 94 — Rectum, Anus, and Perineum by tackling the scenario that breaks surgeons:

The incision healed… and the dog is incontinent.

This is the rectal physiology trap: we grade success by closure, but the owner grades success by function. And in rectal surgery, healing does not equal continence.

You’ll learn the continence system as a four-part machine — and why damaging even one component can turn a technically “perfect” procedure into a life-altering failure:

• Internal anal sphincter (IAS): the automatic baseline seal
• External anal sphincter (EAS): voluntary control via the caudal rectal branch of the pudendal nerve
• Rectal reservoir/compliance: the “storage tank” that prevents pressure spikes
• Neurologic control: the wiring harness (pudendal/pelvic/hypogastric pathways)

Then we break down the three killers that drive post-op incontinence:

denervation, tension, and loss of compliance — plus the deceptive timeline where swelling masks failure early, and the “real score” shows up weeks later.

Bottom line: you don’t win when the incision heals. You win when the patient stays continent.

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In this BoardsCast episode, we continue Tobias Chapter 94 — Rectum, Anus, and Perineum by dismantling the most dangerous assumption in “routine” perineal surgery:

“Anal sacs are gross… just cut them out.”

Anal sac disease is usually not a surgical problem at its core. It’s an inflammatory drainage disorder driven by an obstruction cascade: impaction → inflammation → infection → abscess → rupture. And here’s the trap: rupture doesn’t fix the disease — it destroys your anatomy, so if you operate in the hot, swollen phase, you’re operating blind.

This is where “minor procedure” becomes catastrophe, because the anal sacs sit between the sphincters, millimeters from the caudal rectal nerve and continence system. The biggest surgical disasters here are usually anatomic, not bacterial.

You’ll learn:

• The obstruction cascade and why abscess rupture is a false finish line
• Why acute inflammation makes tissue “lie” (planes disappear, friable tissue, no landmarks)
• The danger-zone anatomy: internal/external sphincter + caudal rectal nerve = continence on a knife edge
• When medical management is the right move (flush, antibiotics, pain control, restore drainage)
• True surgical indications: recurrence, chronic fibrosis/duct obstruction, fistulas, and neoplasia suspicion
• Why technique matters less than precision (open vs closed isn’t the point — millimeters are)
• Failure patterns boards love: fecal incontinence, stricture, incomplete excision → recurrence

Bottom line: don’t turn a temporary inflammatory problem into a permanent functional disability.

🎁 Simini Bonus

Claim your free sample of Simini Protect Lavage (just cover shipping):
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In this BoardsCast episode, we continue Tobias Chapter 94 — Rectum, Anus, and Perineum by confronting the most dangerous belief in rectal repair:

“If the sutures hold, the repair holds.”

That’s the suture lie.

Rectal failures are usually not knot failures — they’re biology failures inside a rigid pelvic cage, where three forces decide whether the patient survives:

contamination + tension + perfusion.

This episode builds the board-level failure framework for why rectal repairs can look stable in the OR, then dehisce in the post-op day 3–5 window when tissue strength drops, swelling peaks, and tenesmus turns a “tension-free” repair into a strangled one.

You’ll learn:

• Why rectal tears are inoculation events (anaerobes + contamination drive rapid failure)
• Why pelvic anatomy creates hidden tension after anesthesia wears off (tone + edema + straining)
• Why “pink” is a trap: perfusion can be compromised even when tissue looks viable
• The predictable dehiscence timeline: microleak → inflammation → edema → perfusion loss → necrosis
• The board pattern: day 3–5 decline = septic dehiscence until proven otherwise
• Prevention priorities that actually move outcomes: source control, true tension-free repair, protect blood supply, and aggressive post-op straining control

If you remember one line: sutures don’t save ischemic tissue. Biology wins.

🎁 Simini Bonus

Claim your free sample of Simini Protect Lavage (just cover shipping):
https://www.simini.com/getstarted1620808454519

Listen On: Spotify | Apple Podcasts | Amazon Music