What is a stoma reversal?
A stoma is formed by bringing a loop of bowel (from the colon to form a colostomy or from the small bowel to form an ileostomy) to the surface of the abdomen. A pouch is then worn over the top of the stoma to collect the faeces. A stoma can either be permanent or temporary and reversed after several weeks to months once the bowel has had time to heal.
Stoma reversal surgery involves rejoining the piece of bowel that is your stoma with either your colon or your small bowel and then closing the stoma site. Both a colostomy reversal and an ileostomy reversal are performed in the same manner.
A stoma reversal will only be offered if your surgeon is confident that you can regain enough bowel control following surgery. You may have some tests before your surgery to check that your bowel has healed sufficiently and that your anal sphincter muscles are in good working order, including:
- Rectal examination to determine your sphincter muscle strength and your bowel control
- Flexible sigmoidoscopy to see how well your bowel has healed
- An enema to check that there are no leaks with your bowel join
- CT scan to confirm that there is no active disease that could compromise your reversal
Who can have a stoma reversal?
You can be considered for a stoma reversal if you have enough rectum left intact (unless you are having J Pouch surgery in which, a new rectal reservoir will be created from your small bowel), have good anal sphincter muscle control, don’t have any active disease in your bowel or rectum and are generally in good health to get through the surgery.
The timing of you reversal will be carefully considered, you won’t be able to undergo the surgery if you are receiving chemotherapy. The optimum time for reversal is between 3 and 12 months following stoma surgery. This is to ensure that you still have good muscle tone and that you bowel is in a good healthy state for surgery.
Stoma reversal surgery
The procedure to reverse your stoma is usually technically less demanding than the original stoma surgery although this will depend on whether you have any complications such as a hernia, which can be repaired at the same time.
The operation can be performed either laparoscopically (via keyhole) or as an open surgery. Your surgeon will discuss with you which is the most appropriate option for you. A straightforward stoma reversal will take around 1-2 hours to perform under a general anaesthetic.
What to expect after a stoma reversal
For the first 24 hours after surgery you will be advised to stick to liquids only to allow the bowel to rest. After 1-2 days you can then start on a soft diet. You will be encouraged to move around as much as possible to encourage activity back into your bowel and aid your recovery. The average hospital stay ins between three to five days, you will be allowed to leave hospital once you have opened your bowels and are not experiencing any complications.
Once you are discharged home, it is common to feel tired and weak following the surgery. Regular short walks can help you to regain your energy and get you back on your feet. You will need to avoid any heavy lifting for around 6-8 weeks and you can drive again once you are confident that you can do an emergency stop. Again, for most people this will be around the 6-8 weeks post op mark.
Your bowel habits may be erratic for some time following surgery. You may experience loose motions or constipation, urgency, pain when passing motions, sore skin around the back passage, incomplete emptying and a degree of incontinence for up to a few months following surgery.
Regaining bowel control after a stoma reversal
Following your stoma reversal there are some things you can do to help control your symptoms following stoma surgery.
- Diet – you may find it easier to eat small, low fibre meals and gradually increase quantity and variety over time. Drink plenty of fluids to avoid constipation (around 8 glasses per day). Mashed potatoes, bananas, jelly sweets and marshmallow are good for firming up loose stools. Fizzy drinks, alcohol, caffeine high fibre vegetables, spicy foods and fatty foods are more likely to cause diarrhoea so it is worth limiting those at the beginning of your recovery. If you are suffering from wind or cramps fennel or peppermint tea can help ease the pain and trapped wind. It can also be helpful at this time to keep a food diary and record any reactions to certain foods
- Protect your skin – you may find it easier to use unfragranced wet wipes to clean up after each bowel movement. A barrier cream such as zinc, castor oil, Sudocrem, Cavilon or Vaseline can help you to prevent getting chapped and sore skin
- Retrain your bowel – your rectum and pelvic floor muscles are likely to be weaker than before your stoma surgery. This will be because they have been inactive for some time. Pelvic floor exercises can help to strengthen and tone these muscles, which will help you gain better control
Risks and side effects of stoma reversal surgery
All surgeries carry a degree of risk. Below are some side effects and risks that are associated with a stoma reversal. Your surgeon will explain any potential complications in details with you during your pre-assessment.
- Ileus – where the bowel stops working temporarily
- Anastomotic leak – the new join in the bowel can come apart and leak into the abdominal cavity
- Bowel obstruction/ adhesions – due to scar tissue forming in the bowel
- Risk of hernia
- Chest infection
- Blood clots
For further information about a stoma reversal please consult your doctor. Our medical helpline 0800 031 5412 can also help answer certain questions and queries although will not be able to comment on individual case.