Publication Name	World Journal of Critical Care Medicine
Manuscript ID	117985
Country	United States

Category	Surgery
Manuscript Type	Meta-Analysis
Article Title	Surgical fecal diversion vs non-diversion in perineal necrotizing soft tissue infections: A systematic review and meta-analysis
Manuscript Source	Invited Manuscript
All Author List	Marcelo Augusto Fontenelle Ribeiro Junior, Sharon M Henry, Husna Irfan Thalib, Sariya Khan, Agata Grochowska-Krystman, Lucas Fontenelle Vieira, Sachin Reddi and Rafael Dib Possiedi
Funding Agency and Grant Number
Corresponding Author	Marcelo Augusto Fontenelle Ribeiro Junior, Director, FACS, Full Professor, MD, PhD, Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St-Baltimore, Baltimore, MD 21201, United States. drmribeiro@gmail.com
Key Words	Nonsurgical fecal diversion; Perianal sepsis; Flexible fecal management system; Flexi-seal; Colostomy, surgical fecal diversion; Fournier’s gangrene; Fecal incontinence catheter; Evacuation management; Necrotizing fasciitis
Core Tip	This systematic review and meta-analysis of thirty-six studies found no consistent differences between non-diversion and surgical fecal diversion (SFD) in mortality, intensive care unit admission or the number of surgical procedures. Hospital length of stay showed significant heterogeneity, with sensitivity analysis favoring non-diversion after exclusion of one outlier study. Overall certainty of evidence was very low, mainly due to confounding by indication and inconsistent group definitions. These findings do not demonstrate a clear overall advantage of routine SFD and support the need for standardized criteria and prospective studies in Perineal necrotizing soft tissue infections.
Citation	Fontenelle Ribeiro Junior MA, Henry SM, Irfan Thalib H, Khan S, Grochowska-Krystman A, Fontenelle Vieira L, Reddi S, Dib Possiedi R. Surgical fecal diversion vs non-diversion in perineal necrotizing soft tissue infections: A systematic review and meta-analysis. World J Crit Care Med 2026; In press

Received	2025-12-22 07:06
Peer-Review Started	2025-12-22 07:06
First Decision by Editorial Office Director	2025-12-31 08:21
Return for Revision	2025-12-31 08:21
Revised	2026-01-08 16:42
Publication Fee Transferred
Second Decision by Editor	2026-01-27 02:40
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-01-27 08:29
Articles in Press	2026-01-27 08:29
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2220-3141(online)
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