An ileostomy is the result of a surgical procedure that creates an opening in the abdominal wall. Stool then exits through this opening instead of leaving the rectum. Some people have permanent ileostomies, but others may be eligible for an ileostomy reversal.
Colorectal cancer and abdominal trauma are two reasons why a surgeon might create an ileostomy. The ileostomy reduces the risk of bowel leakage into the abdominal cavity, which is potentially life threatening, following surgery.
After successful treatment, a person may become eligible for an ileostomy reversal.
This article describes the ileostomy reversal procedure in more detail, including the possible complications and some recovery tips that may help a person after the surgery.
An ileostomy reversal procedure usually takes about 40 minutes and involves the following steps:
- The surgeon will make a skin incision to access the ostomy down to the abdominal wall fascia, which is the connective tissue over the intestines.
- They will identify the area in which to join the two parts of the intestine.
- The surgeon will then connect the two parts of the intestine. They may refer to this surgical connection as an anastomosis.
- Finally, they will close the fascia and skin incision.
The approach may vary according to how surgeons performed the initial surgery.
For instance, procedures may differ in:
- the incision shape
- how the surgeon closes the anastomosis
- whether or not they choose to close the fascia by applying synthetic mesh to prevent a hernia
A surgeon should discuss the expected approach with the person before surgery and provide them with information on the likely recovery time and possible complications.
The timing of an ileostomy reversal post-surgery can depend on several factors. These may include:
- how a person recovered from their original ileostomy surgery
- a person’s need for chemotherapy or radiation therapy post-surgery
- a person’s cancer stage
- the preference of the individual and the surgeon
According to the authors of a 2021 study, the medical community considers an “early” reversal to take place before 90 days. The authors note that most planned ileostomy reversal surgeries occur 3–6 months after a person’s initial surgery, as long as the individual did not experience any complications from their initial surgery or treatment.
However, the study did not find an increased incidence of complications in people with early stoma closure compared with those with late stoma closure.
Complications that a person may experience after ileostomy reversal surgery include:
- Hernia: A hernia occurs if the bowel protrudes through the muscles in the gut. It might happen at the surgical wound or scar. Older adults are more likely to experience hernias, which usually appear within 2 years of the surgery.
- Anastomotic leak: In 1 in 250 people who have had this surgery, a leak will happen where the surgeon has stitched the bowel together. A person may require more surgery to fix the leak.
- Abdominal collection: This less common complication occurs when infected fluid collects inside the abdomen. A person may experience bloating, pain, a high temperature, and changes in bowel movements. Doctors typically treat abdominal collection by draining the fluid and providing the person with antibiotics.
A person should contact their doctor if they notice any of the following symptoms, which can indicate leaks, obstructions, or infection.
Leaks or obstructions
Symptoms that may suggest a leak or obstruction include:
- worsening abdominal pain
- nausea and vomiting
- difficulty breathing
- feeling generally unwell
- being unable to eat and drink enough
- persistent diarrhea
- difficulty passing urine
Sometimes, the fluid in the abdomen can become infected. A person should call their doctor after surgery if they experience any of the following symptoms:
- increasing pain
- frequent diarrhea
After ileostomy reversal surgery, a person will wait for the surgical incision and ileostomy closure site to heal.
Ileostomy reversal surgery usually has a shorter recovery time than the surgery that created the ileostomy. However, a person may need to spend 3–4 days in the hospital.
A person should be aware that it will take time after surgery for their usual bowel movements to return. At first, a person will have frequent, often small bowel movements and pass gas. They will usually remain in the hospital until their bowel function resumes.
During their stay, healthcare staff will monitor their surgical site to make sure that it is healing well.
The surgical incision itself may take 4–6 weeks to heal completely.
A person should thoroughly discuss the recovery process following ileostomy reversal with their doctor.
As the body gets used to stool leaving the body via the rectum, a doctor may make some of the following suggestions regarding recovery.
A person’s surgeon will suggest a diet that they can follow after their ileostomy surgery. A bland, low fiber diet known as the BRAT diet can help minimize how often a person has bowel movements. BRAT stands for:
- B for bananas
- R for rice
- A for applesauce
- T for toast
Eating several small meals a day can help minimize bloating and discomfort.
There are also some foods that a person should avoid after their ileostomy reversal surgery. These include:
- dairy products
- fruit juices
- high fat meats
- spicy foods
- sugar-free foods
These foods are more likely to cause gas and lead to stomach upset.
Easing bowel movements
Passing stool may be uncomfortable after the surgery, as the rectum must stretch to accommodate stool again.
A person can reduce the discomfort of bowel movements by:
- soaking in warm water, such as in a shallow basin called a sitz bath, up to three times a day
- applying a skin protectant, such as petroleum jelly or zinc oxide cream, to the area around the anus after bowel movements
- using moistened, flushable wipes to clean the anal area after having a bowel movement
- taking medications to soften stool if a doctor prescribes them
A doctor may recommend pelvic floor physical therapy. This therapy can help re-train the pelvic floor muscles to have a bowel movement.
However, most surgeons will recommend waiting until at least 6 weeks after the ileostomy reversal surgery before beginning this therapy.
Ileostomy reversal surgery can help a person return to a more normal stool pattern.
This surgery is usually less extensive and time-consuming than the initial surgery to create the ileostomy. As a result, a person usually recovers faster.
However, the individual may have to navigate new challenges when it comes to diet and bowel movements.
A doctor, dietitian, and pelvic floor physical therapist can help a person recover following this surgery.