An ostomy is a surgically created opening, or stoma, that diverts the flow of waste from the digestive or urinary tract to a pouch worn outside the body. This procedure is often necessary to allow a diseased or injured part of the bowel to heal or to bypass it entirely. An ostomy reversal is the subsequent procedure performed to restore the normal pathway of digestion. The operation involves reconnecting the divided ends of the bowel and closing the opening in the abdominal wall, allowing waste to exit the body through the anus once again.
Defining Ostomy Reversal
Ostomy reversal, sometimes referred to as stoma closure or takedown, is an elective surgical procedure focused on restoring the continuity of the bowel. This procedure is only applicable to temporary ostomies, as permanent ones are created when the lower bowel or anal sphincter muscles are non-functional or removed. The reversal procedure varies based on the type of ostomy being closed.
An ileostomy reversal involves rejoining the end of the small intestine (ileum) to the rest of the bowel, such as the large intestine or the rectum. A colostomy reversal connects the two separated ends of the large intestine (colon). In both scenarios, the fundamental step is the precise surgical reattachment, allowing stool to move through the body’s natural route again.
Patient Eligibility and Timing
Reversal is not an option for every patient and requires a careful medical evaluation to determine candidacy. The initial reason for the ostomy is a major factor; for example, ostomies created for trauma or temporary diversion are more likely to be reversed than those for extensive cancer treatment. The disconnected bowel segment must be healthy, well-healed, and free of active disease, such as inflammation or infection.
The patient’s overall health status and ability to safely undergo a second major surgery are also considered. Surgeons assess co-morbidities to ensure the patient can tolerate anesthesia and the physical stress of the operation. A mandatory waiting period is required to ensure the initial surgical site has completely healed, which usually takes a minimum of 8 to 12 weeks. Many planned reversals occur between three and twelve months after the initial ostomy creation, allowing time for the patient to complete other treatments like chemotherapy.
The function of the anal sphincter muscles must be assessed, as these muscles are responsible for controlling bowel movements. If these muscles were damaged during the initial surgery or are weak, a reversal may lead to significant issues with continence. A successful reversal depends on the lower bowel segment and the anal muscles being functional enough to control the passage of stool.
The Surgical Process
The procedure for ostomy reversal is generally less extensive than the initial surgery, but it involves specific steps. The operation begins with the surgeon making an incision around the stoma site to access the part of the bowel forming the stoma. The loop of bowel is carefully freed from the abdominal wall and brought out so the surgeon can work.
The surgeon removes the stoma itself, trimming away non-viable tissue to reveal healthy ends of the bowel. The most important step is the rejoining of the bowel segments, known as an anastomosis, which creates a continuous, leak-free pathway. This reconnection is typically performed using fine sutures or surgical staples.
The procedure can be performed through an open approach, using the incision around the stoma, or sometimes a minimally invasive laparoscopic technique is used. Once the bowel is successfully reconnected, the surgeon irrigates the area and closes the original stoma site in the abdominal wall. The skin incision is then closed with sutures, completing the reversal and restoring the internal anatomy.
Recovery and Post-Reversal Life
The immediate post-operative period involves a hospital stay, typically lasting a few days until the bowels begin to function again. Patients are initially placed on a liquid diet, which is gradually advanced to soft foods as signs of intestinal movement, such as passing gas, return. Pain management is a focus during this time, and recovery is often easier than the original ostomy creation surgery.
The most significant adjustment after reversal is the re-establishment of normal bowel function, often referred to as bowel retraining. The portion of the bowel below the stoma has been inactive, and the nerves and muscles need time to regain coordination and strength. Patients frequently experience an initial period of increased frequency, urgency, and loose stools, particularly in the first few weeks or months.
Dietary adjustments are necessary, starting with a low-residue diet to minimize stool volume and frequency. Patients should reintroduce fiber-rich foods slowly and may find that small, frequent meals are easier to manage. Temporary skin irritation around the anus is common due to the increased frequency and acidic nature of the stool, requiring careful hygiene and the use of barrier creams.
While the goal is a full return to normal function, long-term bowel habits may be altered compared to pre-ostomy life. Symptoms like urgency and frequency gradually improve over several months to a year as the body adapts. Pelvic floor physical therapy and certain medications can also be helpful tools in managing these functional changes and supporting a return to a regular quality of life.