Surgeons reverse a stoma by making an incision around it, freeing the bowel from the abdominal wall, and rejoining the two ends of the intestine (anastomosis) using stitches or staples, then returning the bowel to the abdomen and closing the skin. The specific technique, like loop stoma closure or Hartmann's reversal, depends on the original surgery, but the goal is always to restore normal bowel continuity so you can have bowel movements through your rectum again.
Although the reversal surgery is usually shorter and technically less demanding than colostomy surgery, it is still considered a major operation. Recovery can take weeks, and bowel function is often not regular at first. Many people notice frequent or urgent passing of stool and loose stools until the intestine adapts.
Most people are moderately sore at the reversal site afterwards, but this can be managed with pain killers. You may feel distended following the procedure, some patients describe this as a feeling of being “bruised and bloated” but as the swelling decreases this discomfort will ease.
A surgeon creates a colostomy or ileostomy by splitting your bowel and redirecting the end of your large intestine (colon) or small intestine (ileum) to an opening in your abdomen (a stoma). Ostomy reversal surgery connects your bowels and closes your stoma, allowing you to poop out of your anus (butthole) once again.
The reversal is a small operation lasting approximately 30 to 60 minutes but still involves a general anaesthetic. You will usually be in hospital for about three to five days. You will have a small wound where your stoma (ileostomy) was.
You may be a good candidate for ostomy reversal surgery if:
Limit foods that irritate your digestive system or cause gas. Limit fizzy drinks, alcohol, and caffeine. Take short walks daily to regain your energy and help your surgery site heal. Exercise also helps keep your bowels moving.
Eating a healthy diet
Technical success rates for colostomy reversal are generally high, with successful reconnection achieved in 90-95% of appropriately selected patients when performed by experienced surgeons.
You will probably be in the hospital for three or four days. This surgery is less complicated than the original surgery. After the ostomy-reversal surgery, you will have an open wound on your abdomen where the stoma was. The wound may require packing and wound care for a few weeks after surgery.
How should I sleep after an ileostomy reversal? It's safest to sleep on your back, especially in the days and weeks following the surgery. If you prefer to sleep on your side, avoid putting pressure on the side where your stoma used to be to prevent any discomfort or pressure on that area.
You will need to fast from midnight on the night before if your surgery is scheduled for the morning, or from 7 am if it is scheduled for the afternoon. No bowel preparation is necessary if you are having reversal of a loop colostomy or ileostomy.
The wound usually closes completely in 8 weeks. Bowel function tends to be erratic up to 6 months after surgery; frequent bowel movements and seepage at night are common in the first few months. The body adapts and this improves gradually over the first year.
According to Dr. P. Ravi Kiran, Chief of the Division of Colorectal Surgery, the colorectal team avoids creating an ostomy if possible, but when it is unavoidable, they plan right from the beginning how they will be able to reverse it within the next six to 12 months.
Depending on the type of operation you have had, you will probably be ready to go home 2 to 7 days after surgery. Before leaving hospital, you will be given an appointment for your post-surgery check-up.
The bowel is cut and one end is brought out onto the surface of the abdomen as a colostomy. The other end is the sewn or stapled closed and the anus is left intact.
The findings demonstrated that early colostomy reversal (performed within 45–120 days) was associated with significantly better outcomes compared to delayed reversal (after 180 days), including lower complication rates, shorter hospital stays, and fewer readmissions and reinterventions.
Medical studies show that for many people, life expectancy with colostomy bag use is nearly identical to those without one, particularly when the underlying cause is non-fatal or successfully treated. Survival rates vary when cancer is involved. But many individuals live for decades post-surgery.
Undergoing colostomy reversal even in the elective setting comes with further risk including overall morbidity up to 50 % and mortality up to 7 % that must be communicated to the patient pre-operatively.
Generally you will recover quickly following stoma reversal. It is normal to feel weak and tired on discharge home, mainly because your body is recovering from the stress of a general anaesthetic and surgery. However, it is important to allow yourself some time to return to normal activity.
You can be considered for a stoma reversal if you have enough rectum left intact (unless you are having J Pouch surgery in which, a new rectal reservoir will be created from your small bowel), have good anal sphincter muscle control, don't have any active disease in your bowel or rectum and are generally in good health ...
Weight loss is common after a stoma reversal because dietary restrictions, often recommended after surgery, can reduce calorie intake. The bowel's adjustment period may temporarily affect nutrient absorption and cause diarrhoea.
You may want to avoid certain foods that are difficult to digest and may cause blockages, such as nuts, fruit and vegetable skins and corn. Most people can return to their normal diet. If you have any concerns, speak with your doctor or stomal therapy nurse and they can refer you to a dietitian.
While we recommend always checking with your doctor, generally speaking, you're safe to fly around four to six weeks after stoma surgery.