Ostomy Reversals

What is an ostomy?

An ostomy is an opening from the inside of your body to the outside that is made during surgery. A bowel ostomy is when a connection is made from your bowel to your abdominal (belly) wall. A bowel ostomy will change where your stool (bowel movement) leaves your body. The stool passes through an opening in your abdominal wall, called a stoma, to the outside of your body.

• When the connection is to the colon, it is called a colostomy.
• When the connection is to the small bowel (ileum or jejunum), it is called an ileostomy or a jejunostomy.

If part of your bowel has disease in it or if it is not working as it should, you may need a bowel ostomy. In some cases, your bowel ostomy is temporary (short-term). With a temporary ostomy, the ostomy can be reversed (changed back) in the future. The stoma can be removed, and the healthy parts of your bowel can be reconnected later (called anastomosis). In some cases, the ostomy is permanent (long-term) and cannot be reversed.

What is an ostomy reversal?

An ostomy reversal is the surgery done to reconnect your bowels and close the opening in your abdominal wall (stoma). After an ostomy reversal, your stool can pass through your bowel and/or your anus again.

Who can get an ostomy reversal and what should I expect?

Not everyone with an ostomy will be able to have it reversed. Your provider will talk with you about your ostomy and if you may be able to have it reversed one day. Your provider will think about:

• Healing: Your bowel must be fully healed from the ostomy surgery or cancer treatments (like chemotherapy or radiation).
• Health Status: You must be healthy enough to have a second surgery.
• Cancer or Disease Status: If there was cancer in your bowel, your provider needs to be sure that the cancer has been removed or is under control. If you had other disease, infection, or inflammation in your bowel, that must be resolved before you can have a reversal.
• Bowel Function: The remaining section of your rectum or anus must be able to hold and pass stool.

Before deciding if your ostomy can be reversed, you may need tests like:

• Endoscopy.
• X-ray.
• Digital rectal exam.
• Blood tests.

If your provider thinks your ostomy can be reversed, surgery will be scheduled. You may need to stop eating the night before your surgery, have an enema, or take a laxative to clean out your bowels.

You will likely have general anesthesia to make you sleep and not remember the procedure. You will likely need to stay in the hospital for a few days. Ask your provider any questions you have about your procedure.

What are the risks of an ostomy reversal?

Risks can be:

• Infection: At the site of your incision.
• Leaks: The new connection (anastomosis) may leak.
• Bowel obstruction (blockage): Scar tissue can sometimes block your bowels.
• Hernia: Tissue bulging can happen due to weakness in your abdominal wall.
• Low Anterior Resection Syndrome (LARS): You may have changes in your bowel habits, like increased urgency (intense need to go suddenly), frequent stools, or clustering (going small amounts often throughout the day), as your body gets used to the changes.

Call your provider if you have any new or worsening pain, swelling, nausea/vomiting, fever, redness or drainage at your incision, diarrhea or constipation, or have trouble keeping food or liquids down.

How can I care for myself after surgery?

After surgery, your provider will teach you how to care for your wound at the old ostomy site or new incision site. You may need to make changes to your diet, like eating a low-fiber diet in the first few weeks after surgery. You can slowly add more fiber to your diet, as tolerated. If you need more help with your diet, talk with your provider about seeing a dietitian.

It is common to have loose, frequent stools, leakage, or even some blood in your stool after surgery. Call your provider if you have a large amount of blood or if you still have bleeding after two weeks.

Do not do any strenuous activities, lift anything heavier than 10 pounds, or do any abdominal exercises for 6 to 8 weeks after surgery. Talk to your provider about starting light daily activities as tolerated once you return home.

Talk with your provider about your ostomy, if you are able to have it reversed, and ask them any questions you have about your surgery.