An ileostomy takedown is a surgical procedure that reverses a temporary ileostomy by reconnecting the small intestine and closing the opening (stoma) in the abdomen. It restores the normal path of digestion so stool passes through the intestines and out through the rectum again, eliminating the need for an external ostomy bag. Most takedowns happen 3 to 6 months after the original surgery that created the stoma.
How the Surgery Works
The procedure is performed under general anesthesia. Your surgeon detaches the small intestine from the stoma site on your abdomen, then reconnects it to the downstream portion of your bowel. This reconnection is called an anastomosis. Once the intestine is rejoined, the surgeon closes all incisions, including the former stoma site.
There are two main techniques for reconnecting the bowel. A stapled anastomosis uses a surgical stapling device, while a hand-sewn anastomosis uses sutures. Research comparing the two in elective surgeries has found that stapled connections lead to faster return of bowel function, shorter hospital stays, lower leak rates, and fewer wound infections. Your surgeon will choose the method based on the anatomy of your specific situation.
Timing and Eligibility
The standard window for takedown is 3 to 6 months after the initial surgery. This gives the original surgical site time to heal fully. Some surgeons now perform early closure within 14 days of the first operation, but this requires imaging beforehand (typically a contrast enema or CT scan) to confirm there’s no leak at the original connection point.
Several factors can push the timeline beyond six months. Adjuvant chemotherapy is the most common reason for delay, accounting for about 35% of delayed cases in one study of 170 patients. Other reasons include ongoing medical illness (22%), a leak at the original anastomosis (14%), bowel obstruction from scar tissue (5%), and narrowing at the connection site (2%). Timing matters: patients whose stomas stayed in place longer tended to have more bowel dysfunction after reversal, with those experiencing significant symptoms having their stomas closed an average of 10 weeks later than those who fared best.
When Reversal Isn’t Possible
Not every temporary ileostomy gets reversed. In the same study, the most common reason for a permanent stoma was advanced (stage IV) cancer, which accounted for 23% of patients who never had reversal. Another 14% of patients simply declined the surgery. Other reasons included cancer recurrence in the pelvis, fistula formation, and being too medically unfit for another operation. Patients who had experienced an anastomotic leak after their first surgery were also significantly less likely to be candidates for reversal.
What to Expect in the Hospital
Hospital stays after an ileostomy takedown typically range from one day to about a week, depending on the complexity of the reversal and how quickly your body recovers. Simpler loop reversals often allow discharge within a day or two. Before you go home, your care team will confirm that you can eat, drink, urinate, and manage pain comfortably.
Many hospitals now use enhanced recovery protocols to minimize opioid use and speed healing. These combine pre-surgical pain relievers (like anti-inflammatory medications) with a nerve block at the surgical site performed during the operation. One hospital’s protocol using this approach cut overall opioid consumption by more than half compared to conventional pain management. The result is less nausea, faster return of bowel activity, and shorter stays.
Risks and Complications
Ileostomy takedown is generally considered a lower-risk procedure compared to the original surgery, but complications can occur. The main concerns are:
- Anastomotic leak: The reconnection site can fail to heal properly, allowing intestinal contents to escape. This is the most serious complication and may require additional surgery.
- Postoperative ileus: The bowel can temporarily “fall asleep” after surgery, causing bloating, nausea, and delayed return of bowel movements.
- Small bowel obstruction: Scar tissue from prior surgeries can kink or block the intestine.
- Wound complications: The former stoma site is particularly prone to infection because it previously held an opening into the intestine.
Research has found that delaying reversal beyond 12 months does not significantly increase the rate of these complications compared to reversal within the standard window, which is reassuring for patients whose takedown gets postponed.
Bowel Function After Takedown
Your bowel will not work normally right away. Expect loose or soft stools initially. It takes several weeks for intestinal activity to settle into a pattern, and the goal is typically 2 to 3 bowel movements per day. The more colon you have remaining, the firmer your stool will be over time, because the colon’s main job is absorbing water.
For patients who had their ileostomy created to protect a low rectal connection (common after rectal cancer surgery), a condition called low anterior resection syndrome, or LARS, is a real possibility. Symptoms include frequent bowel movements, urgency, incomplete emptying, and occasional incontinence. A meta-analysis found that about 48% of these patients experienced major LARS symptoms, while 22% had minor symptoms and 30% had no significant issues. Having had a temporary ileostomy nearly tripled the odds of major LARS compared to patients who never had a stoma, likely because the unused portion of bowel loses muscle tone and function while it’s diverted.
These symptoms do improve with time for many people, but the first several months can be challenging. Pelvic floor exercises, dietary adjustments, and medications that slow bowel transit can all help manage the transition.
Diet During Recovery
You’ll start with clear liquids in the hospital and advance to solid foods as tolerated. A low-residue diet (limiting high-fiber foods like raw vegetables, nuts, seeds, and whole grains) is typical for the first few weeks to give the new connection time to heal and reduce the risk of blockage. As your bowel function stabilizes, you can gradually reintroduce foods. Staying well hydrated is especially important early on, since loose stools mean you’re losing more fluid than usual.