An ostomy is a surgically created opening, called a stoma, that connects an internal organ like the small or large intestine to the surface of the abdomen. This procedure diverts the flow of digestive waste out of the body, collecting it in an external pouch. Ostomies are typically formed to allow a diseased or injured portion of the bowel to heal, often following surgery for conditions such as inflammatory bowel disease, trauma, or colorectal cancer. Many ostomies are intentionally temporary, designed with the expectation of a future reversal to restore normal bowel function. However, some conditions necessitate a permanent ostomy.
Determining Eligibility for Reversal
A potential reversal is a second major surgery, requiring a comprehensive medical assessment to confirm the patient is a suitable candidate. The distinction between a temporary ostomy, such as a loop ileostomy, and a permanent ostomy, often determines eligibility. Surgeons create temporary ostomies to protect a surgical connection lower down the bowel, expecting that the underlying condition will resolve.
The fundamental requirement for reversal is that the original disease or injury is completely healed or in stable remission. The disconnected segment of the bowel, which has been inactive, must also be confirmed as healthy, free from strictures, blockages, or significant scar tissue that could prevent flow.
A patient’s overall health must be strong enough to withstand another operation under general anesthesia. Factors like nutritional status, age, and any other pre-existing conditions are carefully evaluated to minimize surgical risk. Before scheduling the procedure, medical teams typically wait a period of several weeks to many months after the initial ostomy surgery for the internal surgical sites to fully heal and for the body to recover its strength.
Another crucial consideration is the function of the remaining lower gastrointestinal tract, especially the anal sphincter muscles. Tests may be performed to ensure the muscles responsible for bowel control are strong enough to manage stool once the waste is redirected back to the anus. If the underlying condition required extensive removal of the rectum, or if the sphincter muscles are compromised, the risk of severe incontinence after reversal may lead a surgeon to advise against the procedure.
The Ostomy Reversal Procedure
The surgical process to reverse an ostomy aims to reconnect the separated ends of the bowel and close the abdominal opening. This procedure is performed under general anesthesia. The surgeon begins by making a circular incision around the stoma site to carefully detach the end of the bowel from the abdominal wall and surrounding scar tissue.
Once the bowel is freed, the two separated ends of the intestine are brought together. The core step of the reversal is the anastomosis, which is the surgical creation of a new connection between these two bowel segments. This re-establishes the continuity of the digestive tract, allowing stool to once again pass through the lower bowel and out the anus.
The technique for anastomosis can vary, often involving staples or sutures to secure the ends together in an end-to-end or side-to-side fashion. After the internal reconnection is complete, the surgeon places the re-joined bowel back into the abdominal cavity. The final step involves closing the incision where the stoma was located, sometimes using a “purse-string” closure that allows the wound to heal from the inside out, or by closing it directly with sutures.
The complexity and duration of the reversal procedure depend on the type of ostomy. Reversing a loop ostomy is generally simpler than reversing an end colostomy, which requires locating and freeing the previously closed rectal stump. The goal is a secure connection that can withstand the pressure of digestive contents without leaking.
Post-Operative Recovery and Functional Changes
Following the reversal surgery, patients typically remain in the hospital for three to seven days, though this timeframe can be longer for complex end colostomy reversals. Pain management is a focus, and the medical team closely monitors the patient for signs of complications, particularly an anastomotic leak, where the new bowel connection fails. Initial recovery involves a gradual progression from a liquid diet to soft foods as the bowel begins to “wake up.”
The most significant and immediate change after reversal is the return of bowel function, which is often erratic. The newly reconnected bowel and the rectum need a period to adjust to the passage of waste. Patients commonly experience increased frequency of bowel movements, urgency, and loose stool, often referred to as temporary dysfunction.
This adjustment period can last several weeks to months, and the severity is often related to how much of the rectum was removed during the initial surgery. Dietary adjustments, pelvic floor exercises, and medications can help manage the long-term functional changes, which for some, may include occasional urgency or minor issues with stool consistency.