An ileostomy reversal is a surgery that reconnects your small intestine to your colon or rectum, eliminating the need for a stoma bag. It’s typically performed 3 to 6 months after the original ileostomy surgery, once the bowel has healed enough to safely function on its own again. For many people, it represents the final step in recovering from conditions like bowel cancer, inflammatory bowel disease, or emergency abdominal surgery.
How the Surgery Works
The procedure is relatively straightforward compared to the original operation that created the ileostomy. Your surgeon detaches the small intestine from the stoma opening in your abdomen, then reconnects it to the lower portion of your bowel. This reconnection point is called an anastomosis. Once the intestine is rejoined, the surgeon closes all incisions, including the former stoma site.
Surgeons can create the intestinal connection using either surgical staples or hand-sewn sutures. A large review of over 8,800 patients found that stapled connections resulted in lower rates of narrowing at the join site, fewer bowel obstructions, and better continence outcomes. The stapled approach also preserves a strip of tissue in the anal canal that contains sensory nerves, helping you distinguish between gas and stool. Hand-sewn connections remove this tissue, which can affect sphincter pressure, though some surgeons prefer this method when there’s a concern about abnormal cells in that area.
Who Qualifies and When
Most ileostomies are reversed between 3 and 6 months after the initial surgery. This window gives the original surgical site enough time to heal completely. If you’re receiving chemotherapy, the timeline may be pushed further out to allow your body to recover between treatments.
Before scheduling the reversal, your surgical team needs to confirm that the downstream bowel is intact and the original connection has healed properly. Common checks include a physical rectal examination, a flexible endoscopy (where a small camera inspects the bowel from the inside), or a contrast enema (where dye is flushed through the bowel and X-rayed to check for leaks or blockages). The rectal exam is quick and gives reliable information about how the connection site has healed, so it’s almost always part of the evaluation.
What Recovery Looks Like
The average hospital stay after an ileostomy reversal is about 4 days. Bowel function typically returns around day 3 or 4, signaled by passing gas or having your first bowel movement. This is the key milestone your medical team watches for before discharge.
Once your bowels start working again, expect a significant adjustment period. Your first stools will be liquid, and you may have many of them throughout the day. This happens because your colon has been out of use for months and needs time to relearn how to absorb water. The frequent, watery stools typically last 1 to 3 weeks. After that, bowel movements gradually become less frequent and firmer as your colon adapts.
Possible Complications
Ileostomy reversal is considered a lower-risk procedure, but complications do occur. In one study of 79 patients, the most common issues were:
- Postoperative ileus (temporary bowel paralysis): 11.4%
- Surgical site infection: 7.6%
- Gastrointestinal bleeding: 6.3%
- Anastomotic leak (leaking at the reconnection site): 2.5%
Anastomotic leak is the most serious of these. If the bowel leaks at the join, it can cause a dangerous abdominal infection requiring further surgery. Fortunately, it’s also the least common complication.
Surgical site infections are the most frequent complication overall, particularly at the old stoma site. How the surgeon closes that wound makes a real difference. A purse-string closure, where the skin is drawn together in a circle leaving a tiny central opening for drainage, has an infection rate of about 4%. The traditional approach of stitching the wound shut in a straight line has an infection rate of roughly 27%. The circular technique works so well because any fluid collecting under the skin can drain out naturally rather than building up. Italian surgical guidelines now strongly recommend this method based on high-quality evidence. Patients also tend to be more satisfied with the cosmetic result: in one trial, 75% of patients with circular closure were very satisfied with their scar, compared to 20% with conventional stitching.
Long-Term Bowel Changes
For people who had their ileostomy created after rectal cancer surgery, a cluster of ongoing bowel symptoms can develop known as low anterior resection syndrome, or LARS. This isn’t caused by the reversal itself but by the original rectal surgery. Symptoms include frequent bowel movements, urgency (needing to go within minutes of feeling the urge), clustering (passing small amounts of stool repeatedly over a few hours), a feeling of incomplete emptying, and varying degrees of incontinence ranging from minor gas leakage to difficulty controlling liquid stool.
The severity varies widely. Some people experience only mild symptoms that barely affect daily life, while others deal with more disruptive patterns. One encouraging finding from a prospective study is that even patients with higher symptom scores didn’t show a significant drop in overall quality of life, though they did report more trouble with diarrhea and disrupted sleep. Over time, many people develop strategies for managing these symptoms, and bowel function continues to improve for up to a year or more after reversal.
Not everyone who has an ileostomy reversal develops LARS. It’s most associated with surgeries that removed part of the rectum. If your original ileostomy was for a condition like Crohn’s disease or a temporary diversion after colon surgery, your long-term bowel function outlook is generally better, though some period of adjustment is still normal.