Patient education: Colostomy or ileostomy reversal (The Basics)

What is a colostomy or ileostomy? — Colostomy and ileostomy are types of surgery where the doctor cuts the intestine and attaches it to the skin. This creates an opening for bowel movements to leave the body. The opening is called an "ostomy."

The type of ostomy depends on which part of your intestine is connected to the skin (figure 1):

●Colostomy – This is when the opening connects to your large intestine (colon) (figure 2).

●Ileostomy – This is when the opening connects to your small intestine (figure 3).

The hole in the skin is sometimes called a "stoma." This is the medical term for "opening." When you have an ostomy, your bowel movements, or "stool," will empty directly into a small plastic bag or pouch that is worn outside of your body. The bag protects you from odor and wetness.

What is a colostomy or ileostomy reversal? — Sometimes, an ostomy is permanent. Other times, it is only needed for a short time.

Ostomy reversal is a surgery where the doctor sews the ends of the intestine back together. This "reverses" the surgery that was done to make the ostomy. Then, you will be able to go back to having bowel movements like you did before your ostomy surgery. You might have this surgery if your intestine is fully healed and the colostomy or ileostomy is no longer needed.

This surgery can be done in 2 ways:

●Open surgery – During an open surgery, the doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body when they do the surgery.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller cuts in the skin. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for ostomy reversal? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might do tests to make sure that your intestines have healed, and that your anus and rectum are working normally.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Cleaning out your intestines – In some cases, you might need to take medicines to empty your intestines before surgery. This is called "bowel prep."

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during ostomy reversal? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get general anesthesia. This makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision in your belly, near the stoma. Then, they will carefully connect the ends of the intestine back together.

●The doctor will close your incision and cover it with clean bandages.

●The surgery takes about 2 to 4 hours.

What happens after ostomy removal? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Over the next few days, you will start to eat soft foods.

You might be in the hospital for 3 to 5 days after surgery. You will need to have a bowel movement before you go home.

What are the risks of ostomy reversal? — Your doctor will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Bleeding

●Infection

●Ileus – This is a condition in which the muscles in the intestine don't work normally to move air, fluid, and food through it.

●Intestine leaking inside of the belly

●Adhesions – These are areas of scar tissue inside of the belly.

●Problems with constipation or diarrhea

●Hernia

●Intestinal obstruction (blockage)

What else should I know? — Your body will have to get used to having bowel movements like you did before you had an ostomy. At first, it is common to have more bowel movements or need to have bowel movements urgently. These symptoms usually get better.

Ask what problems to look for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Colostomy or ileostomy reversal – Discharge instructions (The Basics)
Patient education: Colostomy or ileostomy surgery (The Basics)
Patient education: Living with a colostomy (The Basics)
Patient education: Living with an ileostomy (The Basics)
Patient education: Ileostomy diet (The Basics)
Patient education: How to care for an ostomy (The Basics)
Patient education: Gas and bloating (The Basics)

Patient education: Gas and bloating (Beyond the Basics)