BACKGROUND: The aim of this study was to evaluate the necessity of preventive colostomy for Fournier's gangrene of the anorectal region. METHODS: The medical records of 37 patients with perianal Fournier's gangrene were evaluated retrospectively. Debridement(s) alone was performed in 18 patients (Group D), while debridement(s) plus Hartmann colostomy was performed in 19 patients (Group D&HC). RESULTS: There were no statistically significant differences between the D and D&HC groups with respect to mean age (p=0.73), sex ratio (p=1.00), diabetes mellitus (p=0.88), concomitant diseases (p=0.57), and number of debridements (p=0.75). The medical and surgical complication and mortality rates and duration of hospital and intensive care unit stays were also not significantly different between the D and D&HC groups (p>0.05). Fecal diversion was done at the initial operation in 11 patients, at second operation in 6 patients, and at third operation in 2 patients. When compared, morbidity rates were similar, but mortality rates were statistically different (p=0.031). CONCLUSION: Fournier's gangrene remains a difficult surgical problem. Despite aggressive multidisciplinary treatment, it still has a high mortality rate. Fecal diversion in the treatment of Fournier's gangrene is controversial. If necessary, preventive colostomy should be performed during the initial debridement.
BACKGROUND: The aim of this study was to evaluate the necessity of preventive colostomy for Fournier's gangrene of the anorectal region. METHODS: The medical records of 37 patients with perianal Fournier's gangrene were evaluated retrospectively. Debridement(s) alone was performed in 18 patients (Group D), while debridement(s) plus Hartmann colostomy was performed in 19 patients (Group D&HC). RESULTS: There were no statistically significant differences between the D and D&HC groups with respect to mean age (p=0.73), sex ratio (p=1.00), diabetes mellitus (p=0.88), concomitant diseases (p=0.57), and number of debridements (p=0.75). The medical and surgical complication and mortality rates and duration of hospital and intensive care unit stays were also not significantly different between the D and D&HC groups (p>0.05). Fecal diversion was done at the initial operation in 11 patients, at second operation in 6 patients, and at third operation in 2 patients. When compared, morbidity rates were similar, but mortality rates were statistically different (p=0.031). CONCLUSION: Fournier's gangrene remains a difficult surgical problem. Despite aggressive multidisciplinary treatment, it still has a high mortality rate. Fecal diversion in the treatment of Fournier's gangrene is controversial. If necessary, preventive colostomy should be performed during the initial debridement.
Authors: Orestis Ioannidis; Loukiani Kitsikosta; Dimitris Tatsis; Ioannis Skandalos; Aggeliki Cheva; Aikaterini Gkioti; Ioannis Varnalidis; Savvas Symeonidis; Natalia Antigoni Savvala; Styliani Parpoudi; George K Paraskevas; Manousos George Pramateftakis; Efstathios Kotidis; Ioannis Mantzoros; Konstantinos George Tsalis Journal: Front Surg Date: 2017-07-10