An ostomy reversal surgery reconnects sections of the bowel after a temporary ostomy. An ostomy involves bringing a portion of the intestine through an opening in the abdomen, called a stoma, to divert waste. This diversion is often temporary, allowing a diseased or injured part of the bowel to heal. The reversal aims to restore natural waste flow through the gastrointestinal tract, enabling normal bowel movements through the anus. This elective procedure allows individuals to no longer manage an ostomy bag.
Candidacy for Reversal
Determining suitability for an ostomy reversal involves evaluation of several factors. A primary consideration is the original reason for the ostomy, often created temporarily to allow the bowel to recover from inflammation, injury, or surgery. The underlying condition that necessitated the initial ostomy must have resolved or be well-managed for a reversal to be considered.
The health of the remaining bowel segments is also assessed. Surgeons confirm there is enough healthy intestinal and rectal tissue to allow for successful reconnection. Imaging studies, such as contrast enemas, and endoscopic evaluations are often performed to ensure the bowel has healed properly and there are no strictures or adhesions that could impede a successful reversal.
A patient’s overall health is another determinant. Individuals must be in good health to tolerate another surgical procedure. This includes assessing their fitness for surgery and ensuring no active infection or other medical conditions that could increase surgical risks. The time elapsed since the initial ostomy surgery is also a factor, with many reversals occurring between three months and one year after the initial procedure, though this can vary based on individual circumstances and the need for other treatments like chemotherapy.
The Surgical Process
Ostomy reversal surgery begins with anesthesia. The surgeon makes an incision around the stoma site. This initial incision allows access to the bowel segments that were previously diverted and brought through the abdominal wall.
The surgeon frees the bowel end that formed the stoma from the abdominal wall. The two bowel ends, separated during initial ostomy creation, are then brought together. These ends are reconnected to restore the continuity of the digestive tract. This reconnection, known as an anastomosis, can be performed using either hand-sewn stitches or surgical staples. The choice of technique depends on the surgeon’s preference and the specific characteristics of the patient’s bowel.
After the bowel segments are rejoined, the surgeon ensures no leaks from the new connection. The portion of the abdominal wall where the stoma was located is then closed. In some cases, the reversal can be performed using minimally invasive techniques, but open abdominal surgery may be necessary depending on the complexity of the case and any complications present. The procedure typically lasts two hours or more.
Post-Operative Care and Recovery
Following ostomy reversal, patients are monitored in a hospital for an initial recovery period, typically three to ten days. Pain management is a key aspect of care, with medication provided to control discomfort. Early dietary progression usually begins with clear liquids, gradually advancing to soft foods as the intestines begin to heal and function.
Monitoring for complications is a continuous process. Healthcare providers watch for signs of anastomotic leakage, which occurs if the reconnected bowel does not heal properly, or other issues like infection. The initial return of bowel function is a milestone, though it may not be immediate or entirely normal. Patients often experience gas, cramping, and a sensation of urgency as their digestive system begins to adapt to the restored pathway.
It is common for the first bowel movements after reversal to be loose or watery, and their frequency may be increased. This is a normal part of the body adjusting to the re-established flow through the lower bowel. The hospital stay continues until the patient is tolerating a light diet, is mobile, and has demonstrated initial return of bowel function.
Potential Outcomes and Long-Term Considerations
After the initial recovery, individuals undergoing ostomy reversal can expect a gradual return to more typical bowel function, though complete normalization may take several months. The body needs time to relearn how to manage waste through the entire digestive tract. Changes in bowel habits are common, including increased frequency of stools, urgency to have a bowel movement, and altered stool consistency, which can range from loose to fragmented. These changes often improve over time, but some individuals may experience persistent issues.
Some patients may experience “low anterior resection syndrome” (LARS), particularly if a portion of the rectum was removed during initial surgery. LARS encompasses a range of symptoms such as increased frequency and urgency, incontinence, and feelings of incomplete emptying. Pelvic floor exercises can help strengthen the muscles involved in bowel control and may be recommended to manage these symptoms. Dietary adjustments, such as modifying fiber intake or using anti-diarrheal medications, can also assist in managing bowel habits.
Long-term complications, though less frequent, can include anastomotic stricture, where the reconnected bowel narrows, or the formation of scar tissue. There is also a risk of incisional hernia developing at the stoma site, with some studies indicating it occurs in about one-third of cases. While many reversals are successful, a small percentage of intended temporary ostomies are never reversed due to ongoing medical conditions, complications, or other health factors. Maintaining open communication with healthcare providers allows for ongoing management of any persistent challenges and helps optimize long-term bowel health.