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OBJECTIVE The aim of this study was to identify the effects of creation of stoma and the use of vacuum-assisted closure systems on postoperative mortality and hospital stay in patients with Fournier's gangrene involving anorectal region. STUDY DESIGN A retrospective study. PLACE AND DURATION OF STUDY Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey, from January 2010 to September 2021. METHODOLOGY A total of 66 patients with Fournier's gangrene with anorectal involvement were selected from hospital records and divided into two groups as alive and exitus. Differences between these two groups and the factors affecting mortality were analysed with the SPSS statistics software, version 25.0. The value of p<0.05 was considered statistically significant. RESULTS The mean age of the patients was 57.9±12.9 years, however, age was higher in exitus group (p=0.013). Debridement count was significantly raised in patients with vacuum assisted closure system (p<0.001). The use of vacuum-assisted closure system was associated with a longer hospital stay (p=0.042). Both stoma creation and the use of vacuum-assisted closure system were not found as risk factors for higher mortality. CONCLUSION Stoma creation and the use of vacuum-assisted closure systems have no effect on mortality in patients of Fournier's gangrene with anorectal involvement. Urogenital involvement may be considered as a risk factors for mortality. KEY WORDS Fournier's gangrene, Vacuum-assisted closure system, Stoma, Anorectal region, Perineum, Mortality.