Fournier's Gangrene and fecal diversion. When, in which patients, and what type should I perform?

Abstract Introduction Fournier's gangrene (FG) is a necrotising fasciitis affecting the perineum and urogenital tissue. The mortality rate is high although early detection and aggressive debridement can reduce mortality by up to 16%. The prevalence of sequelae is very high and a colostomy is often necessary to control the perineal wound. Material and Methods A retrospective study was carried out to recruit all patients operated on by the General Surgery and Urology Departments with a diagnosis of GF at the University Hospital over 22 years. Mortality, The Fournier Gangrene Severity Index (FGSI) and fecal diversion (either surgical (colostomy) or straight (Flexi-seal)) are collected. Results A total of 149 patients met the inclusion criteria. FG´s most frequent cause was a perianal abscess (107 patients - 72%). 18 patients (12%) died of a specific cause of FG. Age (p=0,014) and patients with an oncological history (p=0,038), both were the only mortality risk factors for mortality according to logistic regression. 50 patients required some form of fecal diversion in the postoperative period (32 colostomies and 18 flexi-seal). Neither the use of postoperative fecal diversion (surgical or Flexi-seal) nor the timing of its use had any effect on postoperative mortality. Conclusions One in eight patients died in the immediate postoperative period secondary to FG. Despite improved outcomes, 22% required a colostomy during admission. However, neither the performance of a colostomy nor the timing was associated with decreased FG-associated mortality. Non-invasive methods should be used first and surgical bowel diversion should be postponed as long as possible.