A colostomy is a surgical procedure that creates an opening (a stoma) connecting a section of the colon (large intestine) to the surface of the abdomen. This opening redirects digestive waste into an external collection pouch, bypassing the lower bowel and rectum. The procedure is often a life-saving measure used to treat severe infections, injuries, or diseases like cancer or diverticulitis. A large percentage of colostomies are designed to be temporary and can be reversed to restore natural bowel function.
Distinguishing Temporary and Permanent Colostomies
The potential for reversal is determined primarily by the type of colostomy created during the initial surgery. Colostomies are generally categorized as either temporary or permanent based on the underlying medical need. A temporary colostomy is typically performed to divert the fecal stream and allow a distal portion of the bowel to rest and heal completely after injury, infection, or a surgical connection.
The most common temporary type is the loop colostomy, where a loop of the colon is brought through the abdominal wall. This results in a stoma with two openings: one for stool and one for mucus production. This configuration makes reversal relatively straightforward because the two ends of the colon remain closely connected. Surgeons generally intend to reverse these temporary stomas once the initial condition has fully resolved, often within a few months.
A permanent colostomy, usually an end colostomy, is required when the lower part of the colon, rectum, or anus is either removed or deemed non-functional due to extensive disease. In this procedure, only one end of the colon is brought to the surface to form the stoma, and the remaining lower segment is either removed or surgically closed off. This permanent solution is necessary for cases like low rectal cancer where the sphincter muscles cannot be preserved, making the restoration of natural elimination impossible.
Medical Criteria for Colostomy Reversal
Before a surgeon will consider colostomy reversal, several rigorous medical criteria must be met to ensure the procedure’s safety and success. The underlying reason for the initial colostomy must be completely resolved, meaning any infection, inflammation, or surgical leak must be fully healed. For patients who received the colostomy during cancer treatment, the completion of chemotherapy or radiation therapy is often a prerequisite, as these treatments can compromise tissue healing.
The overall health and nutritional status of the patient are also major factors, as reversal is a significant surgery requiring sufficient physical reserves for a successful recovery. A key assessment focuses on the health and functionality of the downstream bowel segment and the surgical connection (anastomosis) performed during the initial procedure. To confirm the integrity of this distal segment, a diagnostic test called a distal loopogram is frequently performed.
The distal loopogram is a specialized X-ray where a contrast dye is instilled through the stoma into the bypassed colon segment to check for any blockages, strictures, or leaks in the previous surgical site. Additionally, the anal sphincter muscles must be assessed to confirm they are strong enough to maintain control over bowel movements once the flow of waste is redirected. If any of these criteria are not satisfactorily met, the surgeon may advise against reversal due to the high risk of severe complications.
The Colostomy Reversal Procedure
The colostomy reversal operation is typically performed under general anesthesia and is generally a less extensive surgery than the original procedure that created the stoma. The surgeon begins by making a circular incision around the stoma site to carefully free the section of the colon from the abdominal wall and surrounding scar tissue. The exteriorized end of the colon is then gently separated from the skin and mobilized back into the abdominal cavity.
The two ends of the colon—the one that formed the stoma and the resting segment leading to the rectum—are then reconnected in a process called an anastomosis. This reconnection is a critical step and can be accomplished with either surgical staples or fine sutures, creating a continuous digestive tract once more. For a loop colostomy, this process is generally direct since the two ends are already in close proximity.
Reversal of an end colostomy, especially one created after a complex procedure like a Hartmann’s procedure, is more involved as the surgeon must locate and free the previously closed-off rectal stump before performing the anastomosis. Once the bowel is successfully reconnected, the surgeon closes the abdominal wall layers and the skin where the stoma was located. The immediate goal of the surgery is to restore intestinal continuity, allowing waste to pass naturally toward the rectum and anus, with a typical hospital stay ranging from a few days to a week for monitoring.
Recovery and Post-Reversal Adjustments
The period following a colostomy reversal involves significant adjustment as the body relearns its original functions. Patients are monitored closely in the hospital until their bowels begin to function, which is a sign that the new connection is working. At first, a soft, low-fiber diet is recommended to ease the workload on the newly reconnected bowel, with a gradual progression back to a regular diet over several weeks.
A major and expected change is a temporary alteration in bowel habits, which often includes increased frequency, urgency, and loose stools. The distal colon and rectum, having been inactive for months, need time to “retrain” to store and control the passage of waste effectively. This period of adjustment, sometimes called the “bowel retraining” phase, can last for several weeks to months.
Many patients experience temporary minor leakage or difficulty differentiating between passing gas and stool in the early recovery phase due to the anal sphincter muscles being out of practice. Medications to manage diarrhea or thicken stool are often prescribed to help regulate this function. For patients who underwent rectal surgery, symptoms like clustering of bowel movements, urgency, and occasional temporary incontinence are common, but these symptoms generally improve with time, dietary modifications, and pelvic floor exercises.