What Is an Ileostomy Reversal? (2024)

An ileostomy reversal is a technique that rejoins the two ends of your bowel after an ileostomy. Its purpose is to restore bowel function so you can remove waste normally.

This article describes what an ileostomy reversal involves, how to prepare for it, what to expect, and common outcomes.

What Is Ileostomy Reversal?

Ileostomy reversal involves anastomosis—or joining the two ends of the stoma together—and then closing the part of your belly where a surgical opening called a stoma was created to send the contents of your small intestine out of the body. During the ileostomy reversal procedure, stitches or staples are used to rejoin the ends of the bowel that were separated in the ileostomy.

When successful, an ileostomy reversal allows you to return to normal elimination of fecal waste through the rectum. The stoma pouch can be removed.

Ileostomy reversal is performed as an inpatient procedure. It involves either open surgery or a minimally invasive procedure such as keyhole laparoscopic surgery. It can be performed on children and adults.

Various Surgical Techniques

The type of technique your surgeon uses depends on several factors, including:

• The technique used during your ileostomy
• The extent of your disease
• Your overall health

Ileostomy reversal is most often performed using one of the following techniques:

• Stapled side-to-side anastomosis: A technique that uses staples to connect each side of the bowel rather than the two ends
• Hand sewn end-to-end anastomosis: A technique that uses sutures to connect the two open ends of the small intestine using sutures
• Functional end-to-end anastomosis: A technique that uses staples to connect the two open ends of the small intestines
• End-to-side anastomosis: A technique that uses staples or sutures to connect two portions of the intestine with different diameters by joining the end of the more narrow ileum with the side of the colon
  

Contraindications

Even though your ileostomy was intended to be temporary, several reasons can interfere with your eligibility for this procedure (called contraindications). For one, the surgery is reserved for people who can regain adequate bowel control following the procedure.

Contraindications to an ileostomy reversal include the following characteristics:

• Advanced cancer stage, persistent inflammation, ischemia, or another active disease in your bowel or rectum
• Incontinence or expectation of incontinence
• Actively undergoing chemotherapy
• Inadequate anal sphincter muscle control
• Anastomotic leakage (leakage of gut contents when the two ends of the channel aren't properly sealed after an ileostomy)
• Distal intestinal obstruction (partial or complete blockage of the bowel)

Potential Risks

Generally, the reversal of an ileostomy is considered a shorter and more straightforward procedure than the ileostomy surgery. However, about 20% of people who undergo ileostomy reversal encounter postoperative complications.

Potential risks of ileostomy reversal include the following problems:

• Bowel obstruction
• Wound infection
• Anastomotic leak (leaking of contents where the two parts of the intestine were joined together) with bleeding
• Peritonitis due to anastomotic leak
• Intra-abdominal abscess
• Postoperative diarrhea
• Urinary or fecal incontinence
• Deep vein thrombosis (a blood clot that forms in a deep vein, such as the leg)
  

Purpose of Ileostomy Reversal

The purpose of ileostomy reversal is to allow you to release the contents of your bowels naturally, without the need for a stoma bag.

A temporary ileostomy may be used in the management of conditions like diverticulitis, colorectal cancer, and inflammatory bowel disease. The temporary use of stomas can help reduce septic complications from anastomotic leaks and avoid the need for another surgery. Once the underlying acute medical condition has improved, the ileostomy reversal can proceed if you meet the physical criteria for the procedure.

How to Prepare

Your surgeon will give you detailed instructions on preparing for your ileostomy reversal. You may also receive guidelines from the hospital or healthcare facility where your procedure is scheduled. Make sure that you understand what you have to do and clarify any questions or concerns you have before the day of surgery.

If you take daily medication, your surgeon will tell you which drugs you can continue taking before and which ones should be discontinued. Don't use Bayer (aspirin), Motrin or Advil (ibuprofen), Aleve or Naprosyn (naproxen) or other drugs that affect blood clotting within a week of your surgery.

Discuss your alcohol use and smoking habits, if applicable, with your healthcare provider before surgery. These habits can affect you during and after surgery. Limiting your consumption of alcohol and quitting smoking before surgery can help you achieve better outcomes.

General guidelines for preparing for ileostomy reversal include the following rules for the day before surgery:

• Limit your diet to clear liquid.
• Take a laxative as directed.
• Shower with an antibacterial soap.
  

What to Expect on the Day of Surgery

An ileostomy reversal is performed as an inpatient procedure in a hospital or medical facility. It requires the use of general anesthesia. It takes about an hour to complete.

Before you go to the hospital, you will be directed to do the following:

• Do not eat or drink anything, including water, when you awaken unless you are directed to take medication by your surgeon.
• Take another shower with antibacterial soap.

When you arrive, you will change into a hospital gown. After meeting with a nurse and anesthesiologist before surgery, you will be taken into an operating room. An anesthesiologist will place an intravenous (IV) line in one of your veins. Anesthesia will be administered through the IV line to keep you asleep during the procedure.

Recovery

Most people remain in the hospital for two to four days after an ileostomy reversal. Your specific treatment plan may vary based on other factors, including your overall health and the outcome of your surgical procedure.

When you awaken in the recovery room, you can expect the following:

• An IV tube in your vein to deliver medication
• A catheter in your bladder to drain your urine for the first 24 hours after surgery
• Sequential compression devices, or leg wraps, to inflate with air periodically to help maintain normal blood flow and prevent blood clots in your legs
• An epidural catheter in your back to deliver pain medicine, if necessary
• Dressing over the old ileostomy site

As you recover, you will be encouraged to begin walking around. Movement can reduce your risk of pneumonia and blood clots. It can also promote passing gas and bowel movements, which are key indicators of surgical outcomes. Coughing, deep breathing, and an incentive spirometer (a device to exercise your lungs) may also be encouraged to promote lung health.

Being approved for discharge from the hospital usually involves meeting the following requirements:

• Stable vital signs (blood pressure, heart rate, and body temperature)
• Pain relief achievable with oral pain medication
• Ability to pass gas or move your bowels
• Ability to eat solid foods
• Ability to get in and out of bed with little or no help
  

Long-Term Care

Upon your discharge from the hospital, you will receive information on what to expect during your long-term recovery. Your instructions will be specific to the procedure performed along with any unique considerations regarding your condition.

Generally, long-term care for an ileostomy reversal includes the following factors:

Incision Care

Your incision may be closed with Steri-Strips, glue, or staples. You will receive instructions on how to care for your incision before you are discharged from the hospital. In most cases, your dressing must be changed daily until the area heals.

As your incision heals, contact your physician if you notice any of the following changes at the site of your incision:

• Red skin spreading away from your incision
• Increased swelling
• Increased drainage
• Opening of the surgical incision

Physical Activity

While daily movement like walking or climbing stairs can help promote your recovery, you will likely have to follow the following restrictions for at least four weeks after your ileostomy closure:

• No lifting of anything that weighs more than 10 pounds
• No pushing or pulling of heavy objects
• No activity that uses your abdominal muscles, which can increase your risk of hernia (a gap that forms in a weak spot of your intestine, creating a painful bulge)
• No participation in contact sports
• No strenuous activities

Your healthcare provider will advise you when it's safe to resume driving and return to work.

Exercises

You may be advised to perform the following types of exercises to help your body heal and avoid complications from your procedure:

• Breathing exercises to prevent pneumonia
• Kegel exercises to tighten your pelvic floor muscles and your anal sphincter muscle

Bowel Movements

When your bowel function resumes, you may experience irregular movements since you have not used the lower part of your colon in a while. Your bowel movements can include the following characteristics as your heal:

• Frequent bowel movements, especially if part of your rectum was removed since you can't store as much stool as normal
• Irregular bowel movements, ranging from several times an hour to several times a week
• Inability to fully empty your bowels

Nutrition

You will receive instructions on the foods most appropriate for your condition. You may have to change the diet you had before surgery to avoid diarrhea or other bowel irritation. You may be advised to do the following:

• Eat five or six small meals throughout the day instead of three large meals.
• Consume eight to 10 8-ounce glasses of liquids.
• Take a fiber supplement, probiotics, or medications to help regulate bowel movements and the feeling of urgency.

Summary

An ileostomy reversal rejoins the two ends of your bowel that were cut after an ileostomy. The purpose of this surgery is to restore bowel function so you can relieve yourself naturally.

Not every ileostomy can be reversed. You must meet certain guidelines to be able to move fecal matter through your rectum before you can reverse the treatment. This often requires waiting up to 12 months after the first surgery so your body can heal. If you need treatment for cancer or other issues, you must complete that before your stoma is closed and before returning to normal bowel movements.