An ileostomy reversal is a surgical procedure that restores bowel continuity after a temporary ileostomy. This article provides a detailed overview of the procedure, potential complications, and crucial dietary guidelines to support a smooth recovery.
What is an Ostomy Reversal?
An ostomy reversal is a surgical procedure performed to reconnect the bowel and close the stoma, reversing a colostomy or ileostomy. A surgeon creates a colostomy or ileostomy by splitting your bowel and redirecting the end of your large intestine (colon) or small intestine (ileum) to an opening in your abdomen (a stoma). After the bowel has recovered from injury or disease, patients may be eligible for ostomy reversal surgery, allowing them to eliminate waste through the anus once again.
Why is Ostomy Reversal Done?
Ostomy reversal is an elective procedure that offers a return to pre-ostomy bowel function. Most people choose to have it because they’d prefer to use the bathroom in the old-fashioned way again. This procedure represents a chance to return to the way life was before ostomy surgery. The procedure alleviates the practical and psychological burdens of managing an ostomy bag, caring for the stoma, and dealing with potential complications like leaks and skin irritation.
When Can a Colostomy or Ileostomy Be Reversed?
The possibility of ostomy reversal is typically discussed before the initial colostomy or ileostomy. This depends on the underlying condition, the treatment required, and the patient's recovery. Ostomy reversal may not be an option for everyone. Your surgeon will discuss the possibility of ostomy reversal with you before your original colostomy or ileostomy procedure.
If the ostomy is expected to be permanent, it may be created in a more permanent manner (end ostomy). However, if it is anticipated to be temporary, a less permanent approach (loop ostomy) may be used. Some individuals require permanent ileostomies, while others may be candidates for ileostomy reversal. The timing of an ileostomy reversal post-surgery may be different for each individual, depending on several factors.
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The Ileostomy Reversal Procedure
An ileostomy is created when a surgeon makes an opening in the abdominal wall, diverting stool through this opening instead of the rectum. 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.
The ileostomy reversal procedure typically takes about 40 minutes and involves these steps:
- Incision: The surgeon makes a skin incision to access the ostomy, reaching the abdominal wall fascia.
- Intestinal Connection: The surgeon identifies the areas to be joined and connects the two parts of the intestine, creating an anastomosis.
- Closure: The fascia and skin incision are then closed. The approach may vary according to how surgeons performed the initial surgery.
The surgeon should discuss the expected approach with the person before surgery and provide them with information on the likely recovery time and possible complications.
Timing of Ileostomy Reversal
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. A 2015 study reported increased complication rates among people who had a gap of more than 6 months between their initial surgery and ileostomy reversal.
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Potential Complications
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: A leak at the site where the bowel was reconnected. 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: An accumulation of infected fluid inside the abdomen. 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.
Post-Surgery Recovery and Diet
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.
Initial Dietary Guidelines
The initial diet after ileostomy reversal focuses on minimizing bowel movements and promoting healing. A person’s surgeon will suggest a diet that they can follow after their ileostomy surgery. Key recommendations include:
- Bland, Low-Fiber Diet: 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
- Small, Frequent Meals: Eating several small meals a day can help minimize bloating and discomfort.
- Hydration: Drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day. This will help you replace the water lost through your ileostomy and keep you from becoming dehydrated (losing more fluid from your body than usual).
- Limit Evening Intake: Don’t eat too much in the evening.
Foods to Avoid
There are also some foods that a person should avoid after their ileostomy reversal surgery. These include:
- Chocolate
- Coffee
- 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.
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Managing 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
Additional Tips for Recovery
- Physical Therapy: 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.
- Monitor Output: Throughout each day, keep track of your liquid intake (how much liquid you drink). You should also keep track of your ostomy output (how much liquid comes out of your ileostomy). Record your liquid intake and ostomy output. You can use the table in the resource Liquid Intake and Ostomy Output Log. Call your doctor’s office if your output is more than 1000 milliliters (about 34 ounces) per day or is watery.
- Electrolyte Replacement: When you have an ileostomy, you lose much more salt, potassium, and water than usual. Eat foods that contain electrolytes. Electrolytes, such as sodium and potassium, can help prevent dehydration. Drink sports drinks (such as Gatorade or Powerade) and oral rehydration solutions (such as Pedialyte). These drinks will help replace your fluid loss quickly, especially if your ostomy output is high. A high output is more than 1000 milliliters (about 34 ounces) per day.
- Avoid 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. Don’t have artificial sweeteners, such as sorbitol, mannitol, and xylitol.
Gradual Introduction of Foods
After surgery you may have some food intolerances that you didn’t have before surgery. A food intolerance is when eating a certain type of food causes uncomfortable symptoms, such as diarrhea, bloating, gas, or bad odor. When you add foods back into your diet, introduce them 1 at a time. If a certain food causes uncomfortable symptoms, don’t eat it for a few weeks. Then try it again. No 2 people will react the same way to food.
At your first follow-up appointment, about 2 weeks after your surgery, your doctor will tell you if you can start adding high-fiber foods back into your diet. When you start adding high-fiber foods back into your diet, do it slowly. Only add 1 food at a time. Make sure you’re also drinking enough liquids.
Signs of Dehydration
If you have any of the following signs of dehydration, call your doctor’s office right away:
- Dizziness
- Lightheadedness
- Dark urine
- Decreased urination
Managing Specific Issues
- Diarrhea: If you’re experiencing diarrhea (having loose or watery bowel movements, having more bowel movements than what’s normal for you, or both), call your doctor’s office. Drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids throughout the day. Don’t eat the following foods and drinks: alcohol, caffeinated drinks (such as coffee, tea, and soda), fried foods, greasy foods, spicy foods, sugary foods and drinks. Eat more of the following foods: bananas, white rice, applesauce, toast, yogurt, oatmeal, cream of wheat.
- Constipation: If you’re experiencing constipation (having fewer than 3 bowel movements per week, having hard bowel movements, having a hard time passing bowel movements, or all 3), call your doctor’s office.
- Gas and Odor: For the first few weeks after your surgery, it’s common to have gas in your pouch and a bad odor when you open your pouch. If you’re having problems with gas or odor, talk with your wound, ostomy, and continence (WOC) nurse. Don’t do these things: chew gum, drink carbonated drinks, smoke. Eat less of the following foods: beans, broccoli, Brussels sprouts, cabbage, cauliflower, corn, cucumbers, dairy products, eggs, fish, garlic, onions, prunes, spicy foods. Eat more of the following foods: yogurt, parsley, cranberry juice.
Long-Term Dietary Considerations
After the initial recovery period, the goal is to gradually expand the diet while continuing to monitor individual tolerance. After surgery some people can eat normal foods and have normal output from their stoma. The low fibre diet is often suggested in both diarrhoea and constipation scenarios with a few minor adjustments. Low fibre diets may not be suitable for diabetics. Fibre assists blood glucose levels to remain stable and is at the core of a diabetic diet.
Some general guidelines include:
- Balanced Diet: A balanced diet provides essential nutrients such as proteins, vitamins, and minerals that are crucial for tissue repair and overall recovery.
- Lean Protein: Lean protein is extremely important in quick healing and recovery as it helps in tissue repair and overall recovery of the patient.
- Healthy Fats: Fats provide energy and support the cellular repair system. Remember whatever you take, take it in small quality.
- Hydration: It is really very important, especially after colostomy reversal surgery to maintain hydration status. Drink plenty of water and other drinks.
- Small Meals Regularly: Eat small meals regularly every three to four hours and try to keep your weight stable. A small meal is one that fits in a mug. The size of a side plate is about the right size for a small meal.
- Supplementation: Multivitamin and mineral supplementation may be necessary. If your motions are watery you may need to add Psyllium husk or Metamucil to bind the watery flow.
Example Meal Ideas
- White bread wrap with sliced chicken, Dijon mustard, sliced peeled Lebanese cucumber and a slice of cheese.
- Skin an eggplant and layer spaghetti Bolognese meat with sauce, with lasagna sheets and bake.
Monitoring and Adjustments
After colostomy reversal surgery keep a strict eye on your body’s response which it produces by consuming different types of food items. Remember you are the only one who knows your body very well. Check the consistency of stool. it is ideal to have a soft and well-formed stool. Check the frequency of bowel emptying. Keep and strict check on the signs and symptoms of bloating or diarrhea.
Returning to Normal Activities
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.
Once you are discharged home, it is common to feel tired and weak following the surgery. Regular short walks can help you to regain your energy and get you back on your feet. You will need to avoid any heavy lifting for around 6-8 weeks and you can drive again once you are confident that you can do an emergency stop.