A colostomy reversal is a surgical procedure that restores normal digestive function after a temporary colostomy. The initial colostomy creates a stoma in the abdomen to divert waste. Reversal surgery reconnects the divided intestine, allowing waste to pass naturally.
Eligibility and Timing for Reversal
Eligibility for a colostomy reversal requires a thorough medical evaluation, as not all colostomies are suitable for reversal. A primary consideration is the patient’s overall health and stability, ensuring they are well enough to undergo another surgical procedure. The original reason for the colostomy also plays a significant role; temporary diversions for healing after injury or disease are often candidates for reversal, unlike permanent solutions. The condition of the remaining bowel, including the presence of healthy intestinal and rectal tissue, and the functionality of anal nerves and muscles, must be assessed.
There is a waiting period after the initial colostomy to allow for healing and resolution of the underlying medical issue. This period ranges from three to twelve months, providing time for any inflammation to subside and scar tissue to settle. For individuals who received chemotherapy after their initial surgery, the reversal procedure is delayed until treatment is complete. While most temporary colostomies are reversible, some factors like older age, certain malignant diseases, or cardiovascular conditions may limit a patient’s suitability for the procedure.
The Reversal Procedure
A colostomy reversal is performed under general anesthesia. The surgeon begins by making an incision around the existing stoma site, carefully freeing the loop of intestine from the abdominal wall. Once the bowel is detached from the stoma, the ends of the intestine are prepared for reconnection. This reconnection, known as an anastomosis, involves joining the two ends of the bowel together, either by hand-sewing with sutures or by using surgical staples.
After the bowel ends are joined, the surgeon checks the anastomosis for leaks to ensure its integrity. Finally, the incision site, including the former stoma opening, is closed. The surgery takes between two to four hours, though it can extend if scar tissue removal or hernia repair is needed.
Colostomy reversals can be performed using either an open or a laparoscopic approach. In open surgery, a larger incision may be made, along the same line as a previous surgical scar. Laparoscopic procedures, also known as minimally invasive or keyhole surgery, involve several small incisions through which a camera and specialized instruments are inserted. The laparoscopic method uses the existing stoma site as an entry point, potentially reducing the need for additional incisions. While both methods aim to achieve the same outcome, laparoscopic reversal may offer benefits such as less post-operative pain and a shorter hospital stay.
Post-Surgery Recovery and Considerations
Following a colostomy reversal, patients remain in the hospital for a period ranging from three to ten days. During this time, pain management is provided through medication to ensure comfort. Recovery involves the gradual reintroduction of diet. Initially, patients may start with clear liquids as their bowels begin to heal, progressing slowly to soft foods and then a broader diet as tolerated. Eating smaller, more frequent meals can aid digestion during this adjustment period.
It takes time for the bowel to resume its normal function, and patients should anticipate changes in bowel habits immediately after surgery. Common temporary changes include more frequent bowel movements, looser or watery stools, urgency, and a feeling of incomplete emptying. Some individuals may experience constipation or difficulty distinguishing gas from stool. These symptoms improve over several weeks to months, though for some, it may take up to a year for bowel function to settle into a routine.
Physical activity is gradually resumed, with walking encouraged early to promote bowel function and prevent complications. Patients are advised to avoid heavy lifting for at least six weeks to prevent strain on the abdominal muscles and the surgical site. Regular follow-up care with the healthcare team is important to monitor healing, address any concerns, and provide guidance as the body adjusts to the restored digestive pathway.