Not all colostomies are permanent, some are temporary, and at some point a colostomy reversal (also referred to as colostomy takedown) may be performed. It usually occurs after the colon has been given enough time to properly heal from whatever condition that first required the initial colostomy surgery. When a lot of patients first undergo a colostomy, they may be quite anxious and look forward to the day that it will finally be reversed. However, there are some patients that grow quite accustomed to their new colostomy and their new routine of expelling wastes with the help of colostomy supplies, and decide to forgo reversal completely. This is something one should definitely discuss with their doctor as the time draws near for reversal surgery.
For those preparing for their colostomy reversal, knowing what to expect during and after the procedure can help ease some of the worry of having to go through another surgery. Likewise, knowing what hurdles might be encountered after the surgery should help one prepare for recovery after colostomy reversal and limit the amount of unwanted surprises.
Colostomy Reversal Surgery
Before the procedure, some sort of preparation is usually needed to clean out the colon of fecal matter. Depending on where on the colon the initial colostomy was performed dictates what kind of prep is needed. Those with ascending or transverse colostomies may be able to get by with only needing to fast for 24 hours. Those with a descending or sigmoid colostomy may need to take some form of bowel prep mixture hours before the procedure to flush waste material out of the colon or an enema may be used as well. The doctor or nurse should inform the patient what is needed in their particular case beforehand.
There are usually two different ways in which the reversal procedure can be done. It is either done as an “open” surgery where two or three large incisions are made and the tissue, muscles and skin are pulled back to give the surgeon an unobstructed view and access to the area to be operated on. The second type is called laparoscopic surgery, and it involves making a few much smaller incisions and using an instrument called a laparoscope, a thin, flexible tube like device that has a camera attached to the end of it. This allows the surgeon to see what they are doing on a monitor. The other small incisions are for other tube like devices that may contain instruments such as clasping and cutting tools.
The advantages of laparoscopic colostomy reversal is that the smaller incisions take less time to heal, are usually less painful than much larger incisions and they leave less scarring on the patients abdomen. It is considered minimally invasive surgery whose goal is to shorten recovery time and be less painful for the patient.
Sometimes referred to as keyhole surgery, because of the small incisions used, a laparoscopic colostomy reversal procedure is generally a lot easier on the patient than the original colostomy surgery. After the surgery is over, the patient is well on their way to having normal bowel movements as they did before their colostomy, barring any unforeseen complications.
As with any surgery there are always risks and in a small percentage of cases complications may arise. Some of these may include:
- Failure at reconnection site: The purpose of colostomy reversal is to reconnect two sections of the colon or the colon to the rectum. If the area where this reconnection takes place does not heal properly a leak may occur that allows waste material out of the colon and into the abdominal cavity. This poses serious risk for infection. If this occurs, a subsequent surgery will be needed to clean out the abdominal cavity and to clear up any infected areas, as well as implement another colostomy until the area can heal and any possible infection can be completely taken care of.
- Surgical complications: There are common risks to surgery in general. There is always a chance for an inadvertent injury to the area being operated on. This type of surgery may pose a slightly higher risk for this type of complication than most.
- Anesthesia Complications: Any type of surgery that requires the use of general anesthesia carries the risks commonly associated with the procedure.
- Build up of scar tissue: Occasionally, the site where the colon is reconnected might develop excessive scar tissue. This may cause a partial blockage of the colon. Symptoms of this might include abdominal pain or swelling.
If after surgery, the patient experiences severe abdominal pain, vomiting, swelling or fever the doctor or nurse should be informed and/or immediate medical care should be sought after.
Read more about colostomy reversal complications.
Depending on how long the colostomy was in place, it may take some time for normal bowel movements to return to normal. Since the anus and sphincter muscles were not in normal use during this time they may have weakened. Accidents may happen in the first few days or even weeks until the muscle strength has been built back up and normal control of bowel movements can be maintained. Pelvic muscle exercises in the days or weeks before the surgery may help make the transition go a little bit smoother.
Recovery should not be rushed. Getting proper rest and slowly working your way back to normal is recommended. Before being discharged from the hospital the patient should be informed by their doctor or nurse as to what to expect during their recovery and what potential problems to be on the look out for should anything go wrong. It is imperative that the doctor’s instructions be followed as closely as possible to ensure a proper and healthy recovery from colostomy reversal surgery. Full recovery might take several weeks. For an unlucky minority of patients however, colostomy reversal may not work out as planned and a permanent colostomy may be needed long term.
Read more about colostomy reversal recovery.
In some instances, a patient may have grown used to their colostomy routine and may not have the desire to undergo yet another surgery. They may bypass colostomy reversal altogether. This is something that should definitely be discussed with the physician to get their expert recommendation and see if it is something that would be an option.
For a lot of patients colostomy reversal is something that they just cannot wait for. Getting normal bowel function back, not having to deal with the colostomy bags or pouches and not having a stoma on their belly is something they long look forward to. And while there are some risks involved and it may take a few weeks or even months to return to a “normal” quality of life, colostomy reversal is often a welcome undertaking.