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Ileostomy reversal is surgery to close a temporary ileostomy and restore the path for stool to move through the intestine. An ileostomy is an opening in the belly that connects the ileum, the last part of the small intestine, to the skin. This lets stool pass from your body without going through your colon or anus. A temporary ileostomy may be created to protect a bowel connection while it heals. Or it may be needed when reconnecting the bowel during an earlier operation wasn't considered safe.

Ileostomy reversal also may be called ileostomy closure, ileostomy takedown, reverse ileostomy or stoma reversal. During the procedure, the surgeon frees the ileostomy from the abdominal wall and reconnects the sections of the intestine. A related procedure, colostomy reversal, closes a temporary colostomy.

Bowel habits may be unpredictable at first after ileostomy reversal. Loose stools, more-frequent bowel movements and urgency can occur while the bowel adjusts. How quickly bowel function recovers varies from person to person and depends on the surgery that led to the ileostomy.

Types

There are two main types of ileostomy reversal surgery. The type of surgery depends on whether you have a loop ileostomy or an end ileostomy.

  • Loop ileostomy reversal. A loop ileostomy is made by bringing a loop of the small intestine through an opening in the abdominal wall. It usually is temporary and may be used to divert stool away from another part of the intestine while that area heals.

    During reversal, the surgeon usually works through the existing opening at the stoma site. The bowel is freed from the abdominal wall, and the two parts of the loop are reconnected using stitches or surgical staples. The bowel is then returned to the abdomen.

  • End ileostomy reversal. With an end ileostomy, one end of the small intestine forms the stoma while the other end of the digestive tract remains inside the abdomen. Some end ileostomies are intended to be temporary so that the bowel can be reconnected later.

    Reversing an end ileostomy generally needs more-extensive surgery because the surgeon must locate the bowel that remains inside the abdomen and reconnect the bowel. The exact operation depends on the surgery that was done when the ileostomy was created and the anatomy that remains.

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Ileostomy reversal may be done when an ileostomy was intended to be temporary and the bowel can be safely reconnected. A temporary ileostomy may be created during bowel surgery, such as a colectomy or ileoanal anastomosis (J-pouch) surgery, to divert stool while a bowel connection heals. A temporary ileostomy also may be created when reconnecting the bowel during the original operation isn't considered safe.

Not every temporary ileostomy can be reversed. Before recommending reversal, your healthcare team considers whether the condition that led to the ileostomy has improved, whether the bowel connection has healed and whether you are healthy enough for another operation. The team also may consider how well the remaining bowel and the muscles around the anus that help control bowel movements are likely to work after reversal.

Timing of ileostomy reversal

There is no single timing that is right for everyone. Ileostomy reversal often is done about 2 to 3 months after the original surgery, once the bowel connection has healed. Some people may have reversal sooner, while others need to wait longer because of healing, other health concerns or additional treatment. Your healthcare team decides when reversal is safe based on these factors.

المخاطر

As with any surgery, complications can happen after ileostomy reversal. The risk depends in part on your overall health, the reason for the ileostomy, and the type and complexity of the reversal.

Possible complications include:

  • A temporary slowdown of the bowel, a condition called ileus. The bowel may temporarily slow down or stop moving after surgery. This can delay eating and drinking. Some people may need fluids through a vein or a tube that goes through the nose and into the stomach until bowel function returns.
  • Intestinal obstruction. Scar tissue or other issues can block the intestine after surgery. Some bowel obstructions require another operation.
  • Leakage at the bowel connection. The new connection between the sections of intestine can leak. This is called an anastomotic leak. Treatment may include antibiotics, drainage or another operation. In some cases, another temporary ileostomy may be needed.
  • Infection at the wound site. Infection can develop at the former stoma site. The way the skin is closed can affect this risk.
  • Slow wound healing. The wound at the stoma site may take several weeks to heal, particularly if it is left partially open so that fluid can drain.
  • Hernia at the stoma site. A weakness in the abdominal wall may allow tissue to bulge through after closure. This is called a hernia.

Some people need another operation because of a complication. The healthcare team monitors bowel function, the surgical wound and other signs of complications during recovery.

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Preparing for ileostomy reversal surgery typically involves these steps:

Medical check-ups and tests

Before ileostomy reversal, the healthcare team checks that the bowel has healed and that you are ready for surgery. Tests may include an exam, imaging or endoscopy, which uses a thin, flexible tube with a camera to look inside the bowel.

A contrast study may be used if the healthcare team is concerned about a leak or narrowing where the bowel was joined during a previous procedure. During this imaging test, a liquid called contrast material is put into the bowel. The contrast makes the bowel easier to see on X-rays. This helps your healthcare team check whether the connection has healed and whether any contrast leaks outside the bowel. Routine contrast testing may not be needed for everyone.

Preoperative review

Before surgery, follow your healthcare team's instructions about:

  • Medicines. Your healthcare team tells you if you need to stop or change any medicines before surgery.
  • Eating and drinking. Follow instructions about when to stop eating and drinking before the operation.
  • Bowel preparation. Whether you need to empty your bowel before surgery depends on the type of reversal and the surgical program. Some programs do not require bowel-cleansing medicines before stoma reversal.

Plan for your hospital stay and coming home

Arrange for support at home after the surgery since you may feel tired for a few weeks. Plan for time off work, and avoid heavy lifting during early recovery.

Think ahead to what you might like to have with you while you're recovering in the hospital. Things you might pack include:

  • A robe and slippers.
  • Toiletries, such as your toothbrush and toothpaste and, if needed, shaving supplies.
  • Comfortable clothes to wear home. Loose-fitting clothes are ideal after surgery to avoid pressure on the closed stoma.
  • Activities to pass the time, such as books, magazines or games.

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Before the procedure

Before surgery, you meet with the anesthesia team to review anesthesia and surgical risks.

You then receive anesthesia so that you don't feel pain during the operation. The anesthesia team determines which type is right for you.

During the procedure

For a loop ileostomy reversal, the surgeon usually works through the existing stoma site. The procedure generally involves these steps:

  • Incision around the stoma. The surgeon makes a cut around the ileostomy and carefully separates the bowel from the skin, abdominal wall and nearby tissue.
  • Rejoining the bowel, called an anastomosis. The surgeon reconnects the two sections of intestine using stitches or surgical staples. Both techniques are accepted approaches for loop ileostomy closure.
  • Returning the bowel to the abdomen. Once the ends of the bowel are joined, the surgeon puts the reconnected bowel back inside the abdomen.
  • Closing the abdominal wall and skin. The opening in the abdominal wall is closed. The skin at the former stoma site may be closed completely or drawn together in a circular, purse-string pattern that leaves a small opening so fluid can drain while the wound heals.

An end ileostomy reversal usually is more extensive. The surgeon must locate the bowel that remains inside the abdomen before reconnecting it. The exact operation depends on the surgery that was done when the ileostomy was created and the anatomy that remains. A larger abdominal incision may be needed, depending on the original surgery and the amount of scar tissue.

For a straightforward loop ileostomy reversal, surgery often takes about 1 to 2 hours. An end ileostomy reversal or another more complex reversal may take longer.

After the procedure

After ileostomy closure, the healthcare team monitors your pain, bowel function and surgical wound. You may get fluids through a vein until you are drinking enough on your own. Pain medicine is used as needed during the early recovery period.

You usually begin moving soon after surgery. In some recovery programs, people may sit up within hours and begin walking the same day. Eating and drinking also are restarted gradually as tolerated.

The healthcare team watches for signs that the intestine is starting to work again, such as passing gas and stool. In one study, people had their first bowel movement about 2 to 3 days after surgery, depending on the type of recovery care they received.

Hospital stays vary. Many people stay for several days while bowel function returns and the healthcare team makes sure pain is controlled, food is tolerated, and there are no signs of a surgical-site infection or other complication.

Bowel movements after ileostomy reversal

Bowel function often is unpredictable at first. During the first few weeks, you may have loose stools, more frequent bowel movements, urgency or periods of constipation. You also may have trouble telling the difference between gas and stool.

Gas and bloating may occur while your bowel adjusts. Introduce foods gradually and pay attention to which foods cause symptoms for you.

How your bowel works after ileostomy reversal depends more on the surgery and bowel that remains than on the type of stoma you had. Factors can include:

  • How much colon or rectum was removed.
  • The location of the bowel connection.
  • Previous pelvic surgery or treatment.
  • How well the muscles around the anus that help control bowel movements work. These muscles are called the anal sphincter muscles.

Some people may notice blood or mucus with bowel movements after reversal. This can happen when a part of the colon that wasn't being used becomes inflamed as it begins working again.

There isn't one set length of time to expect loose stools or diarrhea after reversal. For some people, bowel function becomes more predictable over weeks or months. For others, it can take much longer.

If loose stools or constipation are difficult to manage, your healthcare team may recommend medicines such as antidiarrheal medicines, stool softeners or bulking agents. Pelvic floor or anal sphincter exercises may help some people improve bowel control.

Anal soreness and skin care

Frequent or loose bowel movements can irritate the skin around the anus after ileostomy reversal. The area may become sore or irritated or feel like it's burning, especially while bowel function is still adjusting.

To protect the skin, gently wash the area with warm water after bowel movements and pat it dry with a soft cloth. Avoid rubbing the skin. A protective barrier cream may help reduce irritation.

If soreness or skin irritation continues, contact your healthcare team or stoma care nurse for advice.

Diet after ileostomy reversal

Eating usually resumes gradually after surgery as bowel function returns. Some recovery programs restart liquids and then solid foods relatively early when they are tolerated.

At first, a low-fiber diet may be easier to tolerate while the bowel adjusts. Foods can then be added back gradually based on how your digestive system responds.

Some foods may make loose stools, gas or bowel urgency worse during the early adjustment period. These can include highly spiced foods, large fatty meals, acidic or citrus fruits, and gas-producing vegetables such as cabbage, Brussels sprouts and onions.

Avoid alcohol for at least 24 hours after surgery and while you are taking prescription pain medicines that can cause drowsiness. After that, ask your healthcare team when it is safe to drink alcohol and whether alcohol may affect your bowel function.

Introduce foods gradually and pay attention to which foods worsen diarrhea, urgency or gas. Your healthcare team can give you more specific guidance based on your surgery and bowel function.

Caring for the stoma site

The former stoma site may be closed completely, or it may be partially closed so fluid can drain while the wound heals.

If part of the wound is left open, gauze or another dressing may be put in or over the opening. In one surgical approach, gauze packing is removed the day after surgery, and the wound is then covered with a dry dressing while it heals from the inside out. The dressing may need to be changed as healing continues.

Healing often takes several weeks. In one study, some wounds were still healing six weeks after loop ileostomy reversal with purse-string closure.

The scar can look different depending on how the stoma site is closed. A linear closure leaves a straight-line scar. A purse-string closure draws the skin inward in a circle and leaves a small opening in the center while the wound heals. The opening closes as the wound heals, leaving a scar at the former stoma site.

The new scar may be more noticeable, firm or raised at first. Over time, scars generally become softer, flatter and less noticeable, and their color may change. Scar appearance can continue to change for 12 to 18 months or longer. The final appearance varies from person to person.

Contact your healthcare team if the wound develops increasing pain, swelling, drainage or other signs of infection.

Pain and recovery

Pain and soreness are expected after ileostomy reversal. Pain medicine is used during the early recovery period.

Pain should gradually improve as the surgical site heals. The amount and duration of pain vary depending on the type of reversal and how extensive the operation was. Reversal of an end ileostomy generally involves more surgery than reversal of a loop ileostomy and may have a longer recovery.

Physical activity

Begin with gentle activity, such as walking, after surgery. Gradually increase how far and how long you walk as your strength returns. Light lifting may be possible after you leave the hospital, as long as it doesn't cause pain.

Avoid heavy lifting and strenuous use of the abdominal muscles while the abdominal wall heals. It may take at least 10 weeks before you are ready for heavy lifting or full use of the abdominal muscles.

After the abdominal wall has healed, you can gradually return to more demanding exercise and rebuild your core and abdominal strength. How quickly you can increase exercise intensity depends on your recovery and the surgery you had. Ask your healthcare team when it is safe to return to running, sports, heavy lifting and abdominal-strengthening exercises.

Driving can usually resume when you can comfortably control the vehicle and make an emergency stop without pain.

When to call your healthcare team

Contact your healthcare team if symptoms are getting worse instead of gradually improving or if you have signs of a complication after ileostomy reversal.

Call your healthcare team for concerns such as:

  • Increasing pain, swelling or drainage at the stoma site.
  • Worsening stomach pain or swelling.
  • Persistent vomiting.
  • Trouble passing stool or gas.
  • Significant or persistent rectal bleeding.
  • Severe or persistent diarrhea or signs of dehydration.

These symptoms can be linked to issues such as surgical-site infection, slowdown of the bowel, intestinal obstruction or leak at the bowel connection.

Follow the discharge instructions from your surgical team for when to seek urgent care.

النتائج

After ileostomy reversal, you no longer need a stoma bag because stool passes through the anus again. Bowel function may take time to recover, and your bowel habits may be different from what they were before your original surgery.

How bowel function feels afterward depends on the surgery that was done before the ileostomy and how much bowel remains. Some people continue to have more frequent bowel movements, urgency or difficulty with bowel control, especially after rectal or pelvic surgery.

There is no single success rate that applies to all ileostomy reversals. Studies define success in different ways, such as whether the stoma is closed, whether major complications occur or whether bowel function is acceptable afterward. Outcomes also vary according to the reason for the ileostomy and the type of surgery that was done.

Some people may eventually need another stoma because of complications, disease progression or bowel function that is difficult to manage.

Follow-up after reversal focuses on recovery, bowel function and any issues related to the surgical site or bowel connection.

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