An ileostomy reversal, also known as stoma takedown or closure, is a surgical procedure to reconnect the bowel and close the stoma, restoring the natural process of waste elimination through the anus. This procedure is typically performed on individuals who had a temporary ileostomy created to allow the bowel to heal after injury or disease. After successful treatment and sufficient recovery, patients may become eligible for an ileostomy reversal, allowing them to return to a more normal lifestyle. Diet plays a crucial role in the recovery process after ileostomy reversal surgery.
Understanding Ileostomy and Reversal
An ileostomy involves creating an opening, or stoma, in the abdominal wall, through which the ileum (part of the small intestine) is brought to the surface. This allows stool to exit the body through the stoma instead of passing through the rectum. Conditions such as colorectal cancer, abdominal trauma, or inflammatory bowel disease may necessitate an ileostomy. The reversal procedure involves reconnecting the ileum to the colon, closing the stoma, and restoring the natural flow of waste through the digestive system.
Who is Eligible for Stoma Reversal?
Several factors determine a patient's eligibility for stoma reversal. These include:
- Having enough rectum left intact (unless undergoing J Pouch surgery, where a new rectal reservoir is created).
- Good anal sphincter muscle control.
- Absence of active disease in the bowel or rectum.
- Overall good health to withstand the surgery.
- Not receiving chemotherapy.
- Optimal timing, usually between 3 and 12 months following the initial stoma surgery.
The Ileostomy Reversal Procedure
The ileostomy reversal procedure typically takes about 40 minutes, although a straightforward stoma reversal will take around 1-2 hours to perform under a general anaesthetic. The surgeon makes a skin incision to access the ostomy and abdominal wall fascia, identifies the area for intestinal reconnection (anastomosis), connects the two parts of the intestine, and closes the fascia and skin incision. The approach may vary based on the initial surgery technique, including incision shape and anastomosis closure method. Surgeons may use synthetic mesh to close the fascia to prevent hernias. The surgeon will discuss the expected approach, recovery time, and potential complications with the patient before surgery.
Timing of Ileostomy Reversal
The timing of an ileostomy reversal depends on factors such as recovery from the initial surgery, the need for chemotherapy or radiation therapy, cancer stage, and individual and surgeon preferences. An "early" reversal may occur before 90 days, but most planned reversals happen 3-6 months after the initial surgery, provided there are no complications. Some studies suggest that a gap of more than 6 months between the initial surgery and ileostomy reversal may increase complication rates.
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The Importance of Diet After Ileostomy Reversal
After undergoing ileostomy reversal surgery, adhering to a specific diet is essential for proper healing, regulating bowel movements, reducing complications, and enhancing overall comfort. The bowel needs time to heal and adjust to its new function. A well-planned diet supports tissue repair, regulates bowel movements to prevent constipation and diarrhea, and minimizes the risk of complications such as bowel obstructions, infections, and excessive gas or bloating. Eating easy-to-digest foods in small, frequent meals enhances comfort during recovery.
Dietary Guidelines After Ileostomy Reversal
Initial Post-Surgery Diet: Low-Residue Approach
Immediately following the surgery, a low-residue diet is typically recommended. The goal is to minimize bowel movements and reduce irritation. This diet should be followed for the first few weeks after surgery.
Foods to Include:
- White bread.
- Refined cereals.
- White rice.
- Lean meat and poultry.
Gradually Introducing Fiber
As the bowel heals, fiber can be gradually introduced to promote regular bowel movements without causing strain.
Foods to Include:
- Oatmeal.
- Peeled apples.
- Bananas.
- Carrots.
- Squash.
Introduce these foods slowly and observe how the body responds.
Hydration
Maintaining adequate hydration is crucial, especially after ileostomy reversal surgery. Drink plenty of water and other fluids, such as herbal teas, clear broth, or herbal solutions. Aim for 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day to replace water lost through the ileostomy and prevent dehydration. Don't drink more than 4 ounces (½ cup) of liquids with meals. Don’t drink any liquids for 1 hour before and 1 hour after meals. It’s important to keep drinking lots of liquids, even if your bowel movements are watery. Drink sports drinks (such as Gatorade or Powerade) and oral rehydration solutions (such as Pedialyte).
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Protein and Healthy Fats
Lean protein sources such as chicken, fish, and eggs are essential for tissue repair and overall recovery. Healthy fats from olive oil, nuts, and avocado provide energy and support cellular repair.
Small, Frequent Meals
Eating small, frequent meals is easier on the digestive system and allows for better nutrient absorption. Aim for six small meals throughout the day instead of three large ones, and avoid eating too much in the evening.
Foods to Avoid After Colostomy Reversal
Certain foods should be avoided after colostomy reversal to prevent irritation, gas, and other complications.
- High-Fiber Foods (Initially): Avoid high-fiber foods immediately after surgery to prevent bowel irritation and increased stool bulk.
- Gas-Producing Foods: Foods like beans, carbonated drinks, and cruciferous vegetables (e.g., broccoli, cauliflower) can cause discomfort and bloating.
- Spicy and Fried Foods: These can irritate the digestive tract.
- Dairy Products: Some individuals may develop temporary lactose intolerance, so it is recommended to avoid dairy products initially.
- Fruits with thick skins: For the first 3 to 4 weeks after your surgery, don’t eat raw fruits with the skin.
- Bananas: For the first 3 to 4 weeks after your surgery, don’t eat more than 1 small ripe banana per day. Eating too much banana may cause an ileostomy blockage.
- Caffeinated beverages: If you drink coffee, choose a dark roast instead of a light roast.
- Alcohol: Limit the amount of alcohol you drink for the first 3 weeks after your surgery. Alcohol can cause you to lose more fluid.
- Sugary drinks: Don’t drink sugary drinks, such as juice and soda. If you want to drink juice, choose 100% fruit juice and dilute it (mix it with water) to reduce the sugar.
- Artificial sweeteners: Don’t have artificial sweeteners, such as sorbitol, mannitol, and xylitol.
Tips for a Smooth Dietary Transition
- Eat Small and Frequent Meals: This is easier on the digestive system and nutrients can be absorbed easily.
- Chew Food Thoroughly: This aids in digestion and reduces strain on the bowel.
- Avoid Gas-Increasing Vegetables: Limit vegetables that increase flatulence, such as cabbage and onions.
- Avoid Alcohol and Fizzy Drinks: Refrain from consuming alcohol or fizzy drinks until completely healed.
- Monitor Progress: Keep a strict eye on your body’s response to different food items. Check stool consistency and frequency, and watch for signs and symptoms of bloating or diarrhea.
Managing Common Post-Surgery Issues Through Diet
Diarrhea
Diarrhea, characterized by loose or watery bowel movements or an increased frequency of bowel movements, is a common issue after ileostomy reversal.
Dietary Recommendations:
- Drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids throughout the day.
- Avoid fried and greasy foods, raw fruits and vegetables, whole grain breads and cereals, and caffeine.
- Eat more bananas, white rice, applesauce, cheese, and creamy peanut butter.
Constipation
Constipation involves having fewer than three bowel movements per week, hard bowel movements, or difficulty passing bowel movements.
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Dietary Recommendations:
- Call your doctor’s office.
- Eat more cooked fruits and vegetables, whole grain breads and cereals, and drink prune juice.
Gas and Odor
Gas and odor are common in the initial weeks after surgery.
Dietary Recommendations:
- Avoid chewing gum, drinking with a straw, and skipping meals.
- Eat less beans, broccoli, cabbage, cauliflower, and Brussels sprouts.
- Eat more yogurt, parsley, and buttermilk.
Long-Term Dietary Considerations
After the initial recovery period, gradually reintroduce a wider variety of foods, paying attention to individual tolerance. Some people have permanent ileostomies, but others may be eligible for an ileostomy reversal. The timing of an ileostomy reversal post-surgery may be different for each individual, depending on several factors. Aim for a balanced diet rich in vitamins, minerals, and antioxidants to support overall health and bowel function.
Potential Complications and How to Prevent Them
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.
- Prevention: Avoid heavy lifting and straining to minimize the risk of hernias.
- 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.
- Prevention: Follow dietary guidelines to reduce strain on the anastomosis site.
- 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.
- Prevention: Maintain a healthy diet to support immune function and prevent infections.
- Ileostomy Blockage (Bowel Obstruction): When your intestine is partly or fully blocked.
- Prevention: If there’s no gas or bowel movements coming from your stoma for 6 hours and you have cramps, pain, nausea (feeling like you’re going to throw up), or all 3, call your doctor’s office right away. If you have cramps, pain, or nausea, follow these tips. They can help move food and gas through your intestine. Don’t take a laxative (medication to help you have a bowel movement). This can make the problem worse.
Long-Term Management of Bowel Habits
Bowel habits may be erratic for some time following surgery. You may experience loose motions or constipation, urgency, pain when passing motions, sore skin around the back passage, incomplete emptying and a degree of incontinence for up to a few months following surgery. Regaining bowel control after a stoma reversal can be aided by:
- Diet - you may find it easier to eat small, low fibre meals and gradually increase quantity and variety over time.
- Drink plenty of fluids to avoid constipation (around 8 glasses per day).
- Mashed potatoes, bananas, jelly sweets and marshmallow are good for firming up loose stools.
- Fizzy drinks, alcohol, caffeine high fibre vegetables, spicy foods and fatty foods are more likely to cause diarrhoea so it is worth limiting those at the beginning of your recovery.
- If you are suffering from wind or cramps fennel or peppermint tea can help ease the pain and trapped wind.
- It can also be helpful at this time to keep a food diary and record any reactions to certain foods
- Protect your skin - you may find it easier to use unfragranced wet wipes to clean up after each bowel movement.
- A barrier cream such as zinc, castor oil, Sudocrem, Cavilon or Vaseline can help you to prevent getting chapped and sore skin
- Retrain your bowel - your rectum and pelvic floor muscles are likely to be weaker than before your stoma surgery. This will be because they have been inactive for some time. Pelvic floor exercises can help to strengthen and tone these muscles, which will help you gain better control