Reversal – Yes or No?

May, 2018

Question:

Hi…looking for suggestions on how to handle a very difficult decision. I am 70 and have a temporary ileostomy. The surgeon is willing to do the take down, but all I have heard is horror stories about the long recovery process. A year at this stage of my life is a long time. I so wanted to be rid of the bag, but now I am not sure. Any insights, experiences would be helpful. Thank you

Response:

Choosing to undergo a reversal (take down) of an ostomy, or opting to live your future with the ostomy, is a challenging decision indeed. The following is intended to provide some information that you will want to consider as your make your reversal decision:

What is a stoma reversal?

Having a stoma reversal operation involves re-joining the ends of your bowel that has been cut and reattached, (anastomosis). This temporary stoma will usually be formed as a loop ileostomy (from the small bowel), or less commonly as a colostomy (from the large bowel).

A reversal will only be suggested if the surgeon considers that the reversal operation will be straightforward and a success.

Reversal operations are usually done, 3 to 12 months after the stoma was first formed. This allows the bowel to heal properly following the original surgery. Once the stoma was formed, the muscle of the pelvic floor and anus can grow weaker from lack of use

Is a ileostomy stoma reversal right for me?

Full recovery from a reversal will take time. You can anticipate the benefits of having a stoma reversal to take from several months to a year, or more to be fully appreciated. Your body will take time to settle down to a pattern that is normal for you. However, even with a successful reversal there will still be a piece of your bowel missing, and this will change the way your bowel works in the long term.

Factors to consider when deciding on the ileostomy stoma reversal:

Infection or inflammation in or around the bowel or join (anastomosis), after your initial surgery.

If you had radiotherapy or chemotherapy, that has an affect the health or function of your bowel.

(For folks who had the initial health issues in the bowel and how near to the anus-the shorter the length of bowel remaining in the rectum after surgery, the more difficult it is to create a join that can avoid affecting the sphincter muscles of the anus. This could increase the risk of being unable to control your bowel movements and the potential to lead to incontinence.)

Questions to ask your physician as you make your decision.

How might a reversal affect my bowel habits?

Depending on which part of your bowel that was affected, and the type of surgery you had at the time, there may be scar tissue and changes in the shape of the bowel which will affect how well it is able to work and store the faeces (poo), at least for the first few weeks or even months. Loose, watery poo and wind can cause problems with urgent feelings of needing to ‘go’ quickly. Occasionally, problems with leaking poo can become an issue for some people, especially in the beginning, until they adapt to their circumstances and find a new routine.

What type of surgery is planned, and what are the possible risks?

The surgery can either be performed using a laparoscopic technique, or as an open operation. Open surgery will follow the same scar line as your first operation.

After the operation:

You will be able to leave hospital 3-10 days after reversal surgery, depending on the type of surgery you had, how the operation went and how well you have recovered generally. As you recover from surgery and establish a new routine, you may be supported by other members of a multi-disciplinary team, such as a dietician, continence nurse advisor, etc.

Stoma reversal surgery can be disruptive to work and social routines, and the rules about no driving and no bending for up to six weeks after surgery will apply once again. You should avoid putting strain on the repaired tissue and bowel by avoiding all heavy lifting or physical work, for up to 10 months. It is important to make arrangements before your surgery for change to your job, or for support for you daily routine.

Jo-Ann L. Tremblay
THE OSTOMY FACTOR Blog-joannltremblay.wordpress.com
FACEBOOK – Author Jo-Ann L. Tremblay
TWITTER @joanntremblay
Author of “The Self-Coaching Toolbox” , “Better With A Bag Than In A Bag”

& “Another BAG Another DAY”, “BAGS Around the World”
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Member OstomyCanada /Medical Advisory Committee Member-
Ostomy Lifestyle Expert
https://www.ostomycanada.ca
Member Arteast – www.arteastottawa.com
Website: jo-annltremblay.com

 

Our friends over at Nurses Specialized In Wound, Ostomy And Continence Canada [NSWOCC] (formerly called The Canadian Association for Enterostomal Therapy (CAET)) have renamed their handy look-up page on their website. It was formerly called “Find An ET Nurse” and is now called “Find a NSWOC“. Click on the image to the left or link here to go to their site.