The aim of the study was to evaluate perineal colostomy as a treatment choice to avoid abdominal colostomy and its physical and psychological consequences. It has been viewed with some scepticism because of its variable outcome. The main studies by investigators involved in this surgical challenge available through Pub Med were reviewed and analysed. The review of the literature shows that a more complex procedure (simple perineal colostomy, smooth muscle sphincter, unstimulated graciloplasty, electrostimulated graciloplasty) does not always guarantee successful continence in the sense of the ability to contain and expel faecal content at will. Perineal colostomy with various technical variations is an alternative to abdominal colostomy but is unable to restore continence in cases of serious impairment of the pelvic dynamics.