Stoma reversal surgery – Everything you need to know

Some types of stomas are permanent, while others are considered "temporary". It is therefore possible for these temporary stomas to be moved back again.

What is a stoma reversal surgery?

Stoma reversal surgery is a surgical procedure in which the section of bowel that has been attached to the abdominal wall is released and moved back to its original position – basically the reversal of a colostomy or ileostomy.

Do I have a temporary or permanent stoma?

This decision depends very much on your underlying disease and is usually discussed with you in detail before your stoma surgery. Your surgeon will explain this to you and will be able to tell you in advance whether your stoma can be repositioned or not. For example, it may depend on whether your bowel is permanently damaged or just needs a break. If you are not sure about this, please speak to your Stoma Care Nurse or doctor.

If you would like to know more about temporary stomas, click here.

Before surgery

Prerequisites for reversel

Right at the beginning, it is important to clarify that not every stoma can be reversed. A urostomy, for example, is always a permanent stoma. In addition, it is also a personal decision if the option of a reversal exists. Not for everyone, a stoma represents a negative incision in life.

Anxious about the operation? Find out here, how you can categorise and manage your feelings more easily.

The overall decision will initially be made by your surgeon. He or she will assess whether it is even possible for you to be surgically reversed, what risks there might be for you and how likely it is that your bowel function will be optimally resumed.

These requirements must also be met:

The sphincter muscle could be saved and is still functional.

The intestinal section involved was successfully relieved and is intact.

Any inflammation of the intestinal areas has healed completely.

Chemotherapy or radiotherapy is not (immediately) necessary.

Medical check-ups

A number of tests will be done to ensure that your surgeon can assess whether your bowel has healed properly and your sphincter muscles are functioning well.

Rectal examination to check the strength of your sphincter muscles and your bowel control.

CT (computed tomography) scan to confirm that there is no active disease that could interfere with reversal.

An enema to ensure that there are no leaks in and around your bowel.

Colonoscopy to see how well everything has healed.

Right time

Once the decision has been made to undergo stoma reversal surgery, the question arises when the best time will be. Ideally, a reversal should be performed between 3-12 months after your initial surgery. In this way, it can be ensured that you have good muscle tone and your bowel is in a healthy condition for the procedure.

If you have had a stoma created due to bowel cancer, a reversal surgery is usually only offered once the chemotherapy has been completed and the bowel has had sufficient time to recover. This usually takes up to 6 weeks after the end of treatment.

After surgery

Every operation is a major intervention in your body. Therefore, give yourself and your body enough time to get used to the new situation and to heal. After approximately 3 to 5 days – depending on your condition – you will be allowed to go home.

Nutrition

In hospital, you will often be advised to only eat liquid food at first in order not to put too much strain on your bowel. A high-fibre diet is then recommended. However, it is important that you listen to yourself and eat what feels good for you. Nevertheless, you should make sure you consume healthy food and drink enough fluids (2 to 2.5 litres/day). These are important for a healthy intestinal flora.

You should avoid the following foods, if possible:

Citrus fruits (oranges, lemons, grapefruit, etc.)

Bloating foods (broccoli, beans, cabbage, onions)

Spicy seasonings

Carbonated and alcoholic beverages

Activity

To give your bowels a little boost, move around regularly. Be careful, to avoid heavy lifting or other physically strenuous activities. Small exercises or short walks are perfectly adequate. This will not only make a positive contribution to activating your normal bowel function, it will also support your overall recovery.

Please always take note: Normally, the bowel is not 100% functional immediately after surgery. It often takes several months for it to get used to its function again. So take it easy and relax. If you have any questions or insecurities, please talk to your Stoma Care Nurse.

Problems and complications

The surgery itself is a relatively simple procedure. Typically, the body needs some time to adapt to the reversal. However, no complications should be expected afterwards. For some patients, though, the post-operative adjustment period can be difficult and in some cases even painful.

Ileus/bowel obstruction

It can often occur that the bowel works quite slowly after the surgery, leading to a blockage. Growths in the scar tissue can also cause a constriction. This completely or partially disrupts the further transport of the bowel contents. This leads to a backlog and consequently to discomfort. Depending on the severity of the ileus, nausea, vomiting and severe abdominal pain may occur.

Tips and tricks on how you can get rid of a (stoma) blockage can be found here.

Anastomotic leak

An anastomotic leak is a rupture of the stitches on your repositioned bowel, which is now leaking. Leackages can occur for various reasons. For example, it can be caused by an error on the part of the surgeon who did not place the incisions correctly under pressure, they leak. Another reason is bad wound healing. Sometimes surgical wounds do not heal well even with all efforts and can lead to a leakages. An anastomotic leak can also develop as a result of an infection. In this case, you will receive antibiotics.

In some cases, anastomotic leaks result in a further operation in which a temporary stoma is created again. This is necessary to relieve the bowel.

Urinary and sexual dysfunctions

These problems are only short-term and disappear completely over time. The risk of urinary and sexual dysfunctions is increased when a end colostomy is reversed. The nerves that control these functions lie very close to the area of a colostomy.

Pain

A wound is always associated with pain – at least until it has healed completely. However, if you continue to experience pain beyond this point, this may indicate an infection. Please contact your doctor or Stoma Care Nurse immediately.

Skin care

After a stoma has been reversed, you will have a wound and afterwards a scar at the position of your former stoma. Always keep your wound clean and avoid using perfumed soaps, lotions or creams. As soon as the wound has healed entirely, you can personalise your skin care to suit your needs.


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