Stoma reversal

A number of different types of stoma reversal operations exist depending on the type of stoma that requires reversal. Usually 6 weeks need to pass after a stoma is formed before a reversal procedure can be undertaken. Sometimes we may need to wait longer in order to allow for the scarring (adhesions) forming inside the abdomen after an operation to settle. You should also give your body time to recover following your first operation. Patients that may undergo chemotherapy after a cancer operation will need to complete their treatment before a reversal is performed and this may take up to a year.

Operation around the stoma

In general a stoma with two openings (loop stoma) can be reversed through an operation around the stoma side. The procedure requires a general anaesthetic. A rim of skin is cut around the stoma and the two loops of bowel are released from the abdominal wall and the bowel loops in the abdomen are checked to ensure everything is in order. The two ends are then joined together (anastomosis) with staples or stitches restoring bowel continuity and the bowel is then reduced inside the abdomen. The hole in the abdominal wall is then closed. The procedure usually takes 30-60min but may take longer if there is significant scarring between the bowel loops.

Hartmann’s reversal

In cases where a single opening is present a bigger operation is required.  This is because the part of bowel that has been taken out of circulation in the past needs to be found inside the abdomen, released and joined to the end that has been used to form the stoma. The procedure where a colostomy is joined to the lower end of the bowel (rectum) is called Hartmann’s reversal. The procedure requires a general anaesthetic and in many occasions can be performed laparoscopically (keyhole). The operation takes place through small incisions on your abdomen, 0.5-1cm typical size, through which gas is inflated in order to create space and make internal organs easy to see. A tiny camera (laparoscope) is then inserted into the abdomen guiding the insertion of further specialised laparoscopic instruments which are used to identify and release the end of bowel to be joined to the stoma end. The stoma is then released from the abdominal wall and the two ends of bowel are then joined together. The closer this joint is to the anus the risk of complications from the joint increases. In order to minimize the effect of these complications a temporary stoma may sometimes be formed upstream to rest the bowel and allow the joint to heal. The stoma can be joined back together at some time after the initial operation with potentially a procedure around the stoma in order to restore bowel continuity. The likelihood of this will be discussed with prior to surgery. A small drain may also be left in the abdominal cavity to prevent the build up of fluid which is removed after a few days. The procedure usually takes 2-3 hours but may take longer if there is significant scarring between the bowel loops.

Before the procedure

Sometimes you may need to use some strong laxatives to empty your bowel 24 hours prior to your procedure. On other occasions an enema may be given approximately 1 hour prior to your procedure. You will be advised whether any special bowel preparation is needed at the clinic.

Recovery

After the procedure you will wake up in a hospital room. You will normally follow the enhanced recovery protocol (ERP). The usual stay in hospital after this procedure is 3-5 days but sometimes this may be longer. You are typically expected to go home once you are eating and drinking, are able to manage the pain and walk unaided and have passed some urine. It normally takes about 2-4 weeks to fully recover from a laparoscopic stoma reversal but it varies from person to person. You should avoid any heavy object lifting or strenuous exercise for at least 6 weeks to reduce the risk of developing a hernia.

Risks of the operation

A laparoscopic stoma formation is a reasonably safe procedure. Risks include complications common to all surgical procedures such as infection, bleeding, blood clots, heart problems, pneumonia, urinary retention, risk of injury to organs inside the abdomen and anaesthetic risks. Complications specific to this operation include the risk of the bowel going into strike for a few days (ileus) and rare but significant risks such as leakage from the bowel joint, collection of fluid/pus inside the abdomen, bowel blockage, damage to other organs inside the abdomen and a risk to your life. In operations involving the lower parts of the rectum there is a risk of bladder and/or erection problems. Some patients may experience some change in their stool consistency following removal of part of their bowel which usually improves with time. Open stoma reversal requires the use of general anaesthesia. A skin incision is made in the middle of the abdomen. The loops of bowel inside the abdomen are released from scar tissue and the end of bowel which will be used to join to the stoma end is identified and released. The stoma is then released from the abdominal wall and the two ends of bowel are then joined together. Recovery after an open stoma reversal is slower and may take a number of weeks before you can return back to normal activities.