A colostomy is a surgical procedure that creates an opening, or stoma, on the abdomen, diverting a part of the colon to allow stool to exit the body into an external pouch. This operation manages certain diseases, injuries, or surgical outcomes affecting the lower digestive tract. A colostomy can be temporary or permanent, determined by the underlying medical condition and the potential for the affected bowel segment to heal. If the issue requiring diversion is reversible, the colostomy is typically temporary, allowing for a subsequent procedure to restore the natural flow of waste.
Reasons for Temporary Colostomy
The primary purpose of a temporary colostomy is to divert the fecal stream away from a specific section of the large intestine, allowing that portion to rest and heal. This diversion is a protective measure, especially following complex surgeries on the lower bowel. When a surgeon removes a diseased part of the colon and reconnects the remaining ends (anastomosis), a temporary stoma is often created upstream to shield the new connection from stool while it mends.
One common scenario requiring this temporary measure is severe, complicated diverticulitis, where inflammation and infection lead to perforation or abscess formation. A colostomy provides immediate relief from blockage or infection while the inflamed tissue recovers. Temporary diversion may also be necessary in cases of trauma to the colon or rectum, allowing injured tissues time to repair themselves.
Cancer treatment may necessitate a temporary colostomy if the tumor causes an obstruction or if the lower rectum or anus is involved in the surgery. Loop colostomies, which bring a loop of the colon to the surface with two openings, are often utilized because they are easier to reverse.
Criteria for Reversal
The decision to reverse a temporary colostomy depends on a thorough assessment of the patient’s recovery and the resolution of the initial problem. A sufficient period must elapse after the initial surgery—typically three to twelve months—to ensure the downstream bowel has fully healed and inflammation has subsided. Waiting this time helps mitigate the risk of complications during the reversal procedure.
Before reversal, medical imaging or endoscopic tests confirm that the previously repaired section of the colon is healthy and free of leaks, strictures, or active disease. The patient’s overall health status is evaluated, ensuring they are strong enough to undergo a second major operation. Functional readiness is also assessed, particularly the health of the rectum and anal sphincter muscles, as these must be able to resume normal control of bowel function after the procedure.
The timing of the reversal is individualized based on the patient’s condition and the type of initial surgery. The standard practice is to wait for several months to allow for significant healing and to reduce the technical difficulty of the reoperation. The surgical team confirms the benefits of restoring intestinal continuity outweigh the risks of a second surgery.
The Colostomy Reversal Procedure
The colostomy reversal procedure, or stoma closure, restores the normal pathway of the digestive tract. The surgery is typically done under general anesthesia, beginning with the surgeon making an incision around the stoma to separate the bowel from the abdominal wall and scar tissue. The freed end of the colon is then prepared for reconnection.
The key step is the anastomosis, the surgical rejoining of the two disconnected ends of the colon. For a loop colostomy, reversal is often simpler, involving the resection of the stoma and the direct rejoining of the bowel. In more complex end colostomy reversals, the surgeon must locate the closed-off segment of the colon or rectum left inside the abdomen and bring it up for reconnection.
Once the bowel is reconnected, the surgeon places the segment back into the abdominal cavity and closes the skin at the former stoma site. Patients typically remain hospitalized for a few days to one week, monitored for the return of normal bowel function. Temporary changes in bowel habits, such as frequent or loose stools, are common after reversal as the body adjusts.