Stoma closure, also referred to as ostomy reversal, is a surgical procedure to close an artificial opening in the abdomen, known as a stoma, which was created to divert waste. The operation aims to reconnect the bowel or urinary tract, restoring normal bodily functions and returning to pre-ostomy digestive or urinary patterns.
Reasons for Stoma Closure
Many stomas are created as a temporary measure, allowing a section of the digestive or urinary system to heal following injury, disease, or surgery. Closure is performed once the underlying medical condition has stabilized or resolved.
Conditions leading to temporary stoma creation include diverticulitis, inflammatory bowel diseases (such as Crohn’s disease and ulcerative colitis), and colorectal cancer treatments. Traumatic abdominal injuries can also require a temporary stoma. These diversions allow diseased bowel segments to rest, recover, or protect a newly reconnected area. The time frame for closure varies, typically six weeks to six months, allowing for recovery and scar tissue softening.
The Surgical Procedure
The stoma closure procedure is performed under general anesthesia. The surgeon begins by making an incision around the stoma to free it from the surrounding skin and muscle.
The surgeon then carefully dissects the bowel, releasing any adhesions or scar tissue. The ends of the bowel are trimmed to ensure healthy tissue for reconnection. The two ends of the bowel are then meticulously stitched or stapled back together, a process known as an anastomosis, to restore the continuity of the digestive tract.
After the bowel is reconnected, it is carefully placed back inside the abdominal cavity. The opening in the abdominal wall is then closed with stitches. The entire procedure takes between 1.5 to 3 hours, though this can vary based on the complexity of the case and the type of stoma being reversed, such as an ileostomy or colostomy.
What to Expect During Recovery
Following stoma closure surgery, patients remain in the hospital for a period ranging from two to five days. During the immediate post-operative period, managing pain is a priority, and medication will be provided to ensure comfort.
Diet progression begins with clear liquids for the first 24 to 48 hours to allow the bowel to rest. As the intestines start to function again, indicated by the passing of gas or a bowel movement, the diet will gradually advance to soft foods and then a regular diet. Patients are encouraged to engage in light activity, such as short walks, soon after surgery to promote bowel activity and aid overall recovery.
Wound care for the incision site is important; instructions will be provided to keep the area clean and dry to prevent infection. Changes in bowel habits are common after reversal, with some individuals experiencing more frequent or loose stools, or even temporary constipation, as the bowel adjusts to its restored function. These changes improve over several weeks or months. It is important to contact a healthcare provider if there is a fever, increasing pain, significant redness or swelling at the incision site, or persistent nausea and vomiting.
Potential Risks and Long-Term Considerations
While stoma closure is considered a safe procedure, it carries potential risks, as does any surgery. General surgical complications can include infection at the incision site, bleeding, and the formation of blood clots. Anesthesia also carries its own set of risks, which will be discussed by the medical team.
Specific to stoma reversal, a risk is an anastomotic leak, which occurs if the newly reconnected bowel segments do not heal properly and leak contents into the abdominal cavity. This can lead to serious infection and may require further surgical intervention. Other complications can include bowel obstruction due to scar tissue or adhesions, or a temporary paralysis of the bowel, known as ileus.
Long-term considerations may include the development of a hernia at the incision site, where abdominal organs or tissue push through weakened muscle. Some individuals might experience ongoing changes in bowel function, such as increased frequency, urgency, or even fecal incontinence, as the body adapts. The overall health of the patient and the nature of the original condition that necessitated the stoma can influence the success and recovery from the closure procedure.