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Relationship between diversional stoma and mortality rate in Fournier’s gangrene: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Fournier’s gangrene (FG) is a rare potentially lethal necrotising infection of the perineum. While the gold standard management is early and aggressive surgical debridement, the evidence in the literature is unclear as to the role and outcomes of diversional stoma.

Methods

A systematic review was conducted to identify studies investigating the relationship between stoma formation and FG. Meta-analyses were performed using a random-effects model.

Results

Twenty-seven studies (n=1482) were included. There was no significant difference in disease severity scores between the stoma and no stoma groups. Mortality rate was significantly higher in patients who required diversional stoma (OR 1.71, 95% CI 1.13–2.59, p=0.01). Significantly more surgical procedures were performed on patients who underwent stoma formation, and the total hospital cost was also higher in this group. This study may have been limited by bias in patients with more fulminant course or sphincter damage requiring stoma as a medical necessity.

Conclusion

These findings suggest that the use of diversional stoma in FG is a predictor of poor outcomes. This study demonstrated that mortality rate remained high and a diversional stoma did not reduce risk of mortality as suggested by smaller case series. Its use should therefore be individualised based on disease severity and sphincter damage.

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Authors and Affiliations

  1. University of New South Wales, Sydney, Australia

    Mina Sarofim & James Wei Tatt Toh

  2. Bankstown-Lidcombe Hospital, Sydney, NSW, Australia

    Mina Sarofim

  3. The University of Sydney, Sydney, Australia

    Angelina Di Re & James Wei Tatt Toh

  4. Westmead Hospital, Sydney, NSW, Australia

    Angelina Di Re & James Wei Tatt Toh

  5. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

    Joseph Descallar

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  1. Mina Sarofim
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  2. Angelina Di Re
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Correspondence to Mina Sarofim.

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Sarofim, M., Di Re, A., Descallar, J. et al. Relationship between diversional stoma and mortality rate in Fournier’s gangrene: a systematic review and meta-analysis. Langenbecks Arch Surg 406, 2581–2590 (2021). https://doi.org/10.1007/s00423-021-02175-z

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