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

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Abstract

Introduction

Fournier’s gangrene (FG) is a necrotizing 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%). Eighteen 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. Fifty 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.

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Data Availability

Data are available for consultation.

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Authors and Affiliations

  1. General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain

    Ana Ortega Ferrete, Luz Divina Juez Sáez, Juan Carlos García-Pérez, Juan Ocaña, Araceli Ballestero, Jose María Fernández-Cebrián & Javier Die Trill

  2. Urology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Enrique López

  3. Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain

    Luz Divina Juez Sáez, Juan Carlos García-Pérez, Juan Ocaña, Araceli Ballestero & Jose María Fernández-Cebrián

  4. Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain

    Juan Carlos García-Pérez

Authors
  1. Ana Ortega Ferrete
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  2. Enrique López
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Contributions

A. Ortega and E. López conducted the data search and drafted the main text of the manuscript. L.D. Juez prepared the figures and tables. All authors wrote, reviewed, and approved the manuscript.

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Correspondence to Luz Divina Juez Sáez.

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Ortega Ferrete, A., López, E., Juez Sáez, L.D. et al. Fournier’s gangrene and fecal diversion. When, in which patients, and what type should I perform?. Langenbecks Arch Surg 408, 428 (2023). https://doi.org/10.1007/s00423-023-03137-3

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