# Comparison of diverting colostomy and fecal management catheter in fournier gangrene: a retrospective cohort study

## TL;DR

This study compared two fecal diversion methods for treating Fournier gangrene and found they had similar outcomes after adjusting for patient age and disease severity.

## Contribution

The study provides evidence that both colostomy and fecal management catheterization are comparably effective for Fournier gangrene treatment.

## Key findings

- After adjusting for age and FGSI score, differences in mortality, hospital stay, and debridement number between the two methods were not statistically significant.
- The higher mortality in the colostomy group was attributed to older age and higher disease severity, not the treatment method itself.
- Both fecal diversion methods can be safely used, with selection based on patient-specific factors and clinical experience.

## Abstract

This study aimed to compare the effectiveness of colostomy and fecal management catheterization, two fecal diversion methods, in the treatment of Fournier gangrene (FG) and to determine which method offers greater advantages.

A retrospective study was conducted on 54 patients who underwent surgical debridement and fecal diversion for FG at our hospital's General Surgery Clinic between January 2014 and October 2024. Patients were divided into colostomy (n = 28) and fecal management catheter (Flexi-Seal) (n = 26) groups for comparison. The primary outcome was in-hospital mortality; secondary outcomes were length of hospital stay, number of debridements, FGSI, and LRINEC scores. Covariate-adjusted analyses (ANCOVA and logistic regression) were performed to control for age and FGSI score differences between groups.

The mean age was 65.07 ± 13.45 years in the colostomy group and 57.92 ± 14.41 years in the Flexi-Seal group (p = 0.100). The mean number of debridements was 3.18 ± 2.58 in the colostomy group and 2.54 ± 1.56 in the Flexi-Seal group (p = 0.539). The mean length of hospital stay was 25.96 ± 16.02 days in the colostomy group and 20.50 ± 11.15 days in the Flexi-Seal group (p = 0.191). FGSI scores were 5.04 ± 3.44 and 3.88 ± 2.72 (p = 0.216), while LRINEC scores were 7.46 ± 2.24 and 7.00 ± 1.65 (p = 0.167) in the colostomy and Flexi-Seal groups, respectively. The mortality rate was 17.8% (5/28) in the colostomy group and 11.5% (3/26) in the Flexi-Seal group (p = 0.51; unadjusted OR 1.67; age- and FGSI-adjusted OR 0.95). The overall mortality rate was 14.8%. After covariate adjustment, the length-of-stay difference narrowed from 5.5 to 2.3 days, and the debridement difference from 0.64 to 0.43—all remaining non-significant. No statistically significant differences were observed between the groups regarding gender distribution and prevalence of comorbid diseases.

Both fecal diversion methods demonstrated comparable effectiveness in FG treatment. After adjusting for age and FGSI score, the observed differences in length of hospital stay, debridement number, and mortality were substantially attenuated—with adjusted mortality OR approaching 1.0 (0.95)—confirming that the diversion method was not an independent predictor of outcomes. The numerically higher mortality in the colostomy group was explained by older patient age and higher disease severity. Both methods can be safely employed; patient-specific factors and clinical experience should guide method selection.