An ostomy is a surgical procedure that creates an opening, called a stoma, on the abdomen’s surface to divert bodily waste away from a diseased or damaged section of the intestine or urinary tract. This diversion allows stool or urine to exit the body into a collection pouch worn externally. While the creation of an ostomy can be a life-saving measure, a significant number of ostomies are intended to be temporary and can be reversed, allowing the digestive system to return to its original function. However, the possibility of reversal is highly dependent on the type of ostomy and a strict set of medical and physiological requirements.
Temporary Versus Permanent Ostomies
Ostomies are broadly classified as either temporary or permanent, a distinction often made at the time of the initial surgery. A temporary ostomy, such as a loop ileostomy or loop colostomy, is typically created to allow a section of the bowel further down to rest and heal after surgery or injury. In a loop ostomy, a segment of the bowel is brought through the abdominal wall and partially opened, leaving the distal portion connected but temporarily unused.
A permanent ostomy, often an end ostomy, is necessary when the distal portion of the bowel or rectum has been entirely removed, is too diseased to function, or the sphincter muscles are non-functional. For instance, following an abdominoperineal resection for rectal cancer, there is no longer a pathway for waste to exit naturally, making the end ostomy permanent. While colostomies and ileostomies are candidates for reversal when temporary, urostomies, which divert urine, are rarely reversed because the underlying issue with the bladder or ureters is usually permanent.
Medical Requirements for Reversal Eligibility
Several clinical criteria must be met before reversal surgery can be scheduled. The primary requirement is that the condition that necessitated the ostomy must be completely resolved or significantly healed. This means any inflammation, infection, or surgical site must show clear evidence of recovery, which typically requires a waiting period of at least three months, but often extends up to twelve months.
The patient’s overall health must be robust enough to withstand another major abdominal operation. Surgeons assess nutritional status, ensure there is no active systemic infection, and confirm the patient is not undergoing concurrent treatments like chemotherapy, which can compromise wound healing. The distal bowel segment, which has been bypassed, must also be healthy, patent, and functional. Tests, such as a contrast study or endoscopy, are often performed to confirm that the intestinal pathway leading to the rectum is open and without strictures.
The Procedure for Reconnecting the Digestive System
The surgery to reverse an ostomy involves reconnecting the two ends of the digestive tract, a process known as an anastomosis. For a loop ostomy, the procedure is often less invasive. The surgeon makes a circular incision around the stoma, mobilizes the section of the bowel, excises the stoma itself, and then re-joins the two ends using surgical staples or sutures.
Reversing an end ostomy, such as one created during a Hartmann’s procedure, is generally a more complex operation. This is because the distal end of the intestine is often deep within the abdominal cavity and must be carefully located and mobilized. The surgeon may need to utilize the original surgical incision to gain adequate access, classifying the reversal as a major abdominal surgery. Depending on the complexity, the procedure may be performed using traditional open surgery or a minimally invasive laparoscopic technique.
Expected Recovery and Post-Reversal Adjustments
Following the reversal procedure, patients are typically hospitalized for three to ten days to monitor for complications and ensure the digestive system is functioning. A significant immediate concern is an anastomotic leak, where the newly connected bowel ends fail to seal properly, which can be a life-threatening complication. The return of bowel function is initially unpredictable, and patients may not experience a bowel movement for several days after the surgery.
Once home, the body requires a significant period of adjustment as the digestive system relearns its original route. Common long-term adjustments involve changes to bowel habits, including increased frequency, urgency, and sometimes mild fecal incontinence, particularly in the first few months. This occurs because the distal bowel and rectum, having been out of use, may have temporarily lost some capacity and sensitivity. Dietary management and targeted exercises, such as pelvic floor muscle training, are often recommended to help restore control.