A colostomy reversal is a surgical procedure designed to close a temporary colostomy and restore the natural flow of waste through the digestive tract. This operation rejoins the two ends of the colon or small intestine that were separated during the initial creation of the colostomy. The goal is to allow stool to pass through the rectum and anus again, eliminating the need for an external ostomy pouch. The procedure is performed once the underlying medical issue that necessitated the colostomy has fully resolved and the patient is healthy enough for surgery.
Understanding the Purpose of Reversal
A temporary colostomy is created to divert stool away from a section of the bowel, allowing that portion to rest and heal. This diversion is often necessary after surgery for conditions like colorectal cancer, severe diverticulitis, inflammatory bowel disease, or following bowel trauma. Once sufficient healing has occurred, typically between three and twelve months, the colostomy can be reversed. This procedure is distinct from a permanent colostomy, which is performed when restoration of normal function is impossible due to the removal of a significant portion of the rectum or anus. Restoring the natural passage of stool and improving quality of life are the main drivers for planning a reversal.
Determining Candidate Eligibility
Before a reversal can be scheduled, surgeons conduct an assessment to ensure the patient is ready for the operation. The most important factor is the complete resolution of the condition that led to the initial colostomy, such as being cancer-free or having all infection and inflammation cleared. Testing, which may include imaging or endoscopy, confirms that the distal bowel segment is healthy and has no leaks or blockages.
The patient’s overall health is a major consideration, as the reversal is a major abdominal surgery requiring general anesthesia. Factors like age and the presence of other medical conditions (comorbidities) are evaluated to minimize the risk of complications. Functional anal nerves and muscles are also assessed, often through a digital rectal exam, to confirm the patient will have sufficient control over their bowel movements after the procedure. Timing is also considered, with many reversals planned for three to six months after the first surgery to allow for adequate healing.
Overview of the Surgical Process
The colostomy reversal is performed under general anesthesia. The surgeon begins by making an incision around the stoma site to carefully free the end of the bowel from the abdominal wall and surrounding scar tissue. The exact surgical approach depends on the type of colostomy initially performed, either a loop or an end colostomy.
Loop vs. End Colostomy Reversal
In a loop colostomy reversal, the two ends of the intestinal loop are close together and are reconnected directly, making it a simpler procedure. Reversing an end colostomy, sometimes called a Hartmann reversal, is more complex. This requires the surgeon to locate and mobilize the other end of the bowel (the rectal stump) from inside the abdomen. Once both ends are mobilized, they are brought together in a procedure called an anastomosis, which is the rejoining of the bowel using stitches or surgical staples.
The surgeon places the newly reconnected bowel back into the abdominal cavity. The abdominal wall and the skin around the former stoma site are closed, sometimes using a purse-string closure to reduce the risk of wound infection. The procedure may use an open technique (larger incision) or a minimally invasive laparoscopic approach, which often results in less pain and a shorter hospital stay. The choice depends on the complexity of the initial surgery and the patient’s anatomy.
Recovery and Long-Term Adjustments
Following reversal surgery, patients typically remain hospitalized for a few days to a week, depending on the procedure and recovery progress. The medical team manages pain and monitors for complications, such as leakage at the anastomosis site. Patients are gradually transitioned from a liquid diet to soft, low-fiber foods as the bowels begin to function again.
The most significant long-term adjustment involves changes in bowel function as the body adapts to the restored pathway. It is common to experience frequent or urgent bowel movements, loose stools, and sometimes minor leakage, as the colon and rectum need time to regain normal function. This adjustment period can last for several weeks or months, with many patients finding their bowel habits stabilize within three to six months. Managing diet is important, focusing initially on easily digestible, low-fiber meals. Patients are often advised to slowly reintroduce foods to determine what they tolerate well. While the reversal restores the natural anatomy, bowel function may not return exactly to how it was before the initial disease and surgery.