Colostomy in Fournier’s Gangrene: is it always necessary?

Aim: Fournier's gangrene is a rapidly progressing necrotizing infection of the perineal, genital, and perianal regions with high morbidity and mortality.The necessity of colostomy in preventing fecal contamination and improving outcomes remains controversial.This study aimed to assess the role of colostomy in patients surgically treated for Fournier's gangrene.Methods: This retrospective single-center study included 107 patients treated for Fournier's gangrene between May 2017 and April 2025.Patients were grouped according to colostomy status.Demographic characteristics, comorbidities, laboratory values, hospital stay, and mortality were compared.Statistical analyses were performed using appropriate parametric and nonparametric tests, with significance defined as p < 0.05.Results: Mortality was significantly higher in the colostomy group (57.14%) than in the non-colostomy group (12.0%, p = 0.009).Colostomy was performed in cases with sphincter injury, advanced fecal contamination, impaired consciousness, or poor treatment adherence.In patients managed without colostomy, meticulous wound care, repeated debridement, and structured patient education effectively controlled fecal contamination.Colostomy was associated with longer hospital stays, additional surgical interventions, increased costs, and reduced quality of life.Conclusion: Routine colostomy is not required in most Fournier's gangrene cases.Early debridement, broad-spectrum antibiotics, and careful wound management are generally sufficient to control infection.Colostomy should be reserved for selected patients, and high-quality postoperative care and multidisciplinary support remain essential for favorable outcomes."