BACKGROUND Perineal necrotizing soft tissue infections (P-NSTI) are aggressive and potentially fatal conditions. Surgical fecal diversion (SFD) is often used to reduce contamination, but whether non-diversion provides comparable outcomes remains uncertain. We hypothesized that non-diversion does not confer worse outcomes than SFD. AIM To evaluate clinical outcomes of non-diversion compared with SFD in adults with P-NSTI. METHODS Systematic review and meta-analysis following PRISMA and Cochrane s