Ostomy Reversal Surgery – What to Expect

What is an Ostomy Reversal?

Ostomy reversal surgery—often referred to as stoma reversal, ostomy takedown, or intestinal reanastomosis—is a surgical procedure that restores intestinal continuity after a temporary ostomy.

What is the Goal of Surgery?

The goal of the operation is to reconnect the previously diverted bowel so that intestinal contents once again pass through the rectum and anus. The specific surgical technique depends on the type of ostomy originally created, such as a colostomy or ileostomy, and the underlying condition that required the diversion.

Note that some reversal surgeries are done in two parts. The first surgery is to convert the colonoscopy to an ileostomy, typically a loop ileostomy. The next surgery is the official ‘take down’, where the stoma is closed and continuity of the digestive tract is officially restored.

The Surgery Itself

Typical reversal surgeries with no significant complications take 1 – 2 hours.

Several methods are used in ostomy reversal surgery, depending on the patient’s condition, prior surgeries, and surgeon preference:

1. Open Surgery

Traditional open surgery involves a larger abdominal incision to access the bowel. It is often used in more complex cases, especially when there is significant scar tissue (adhesions) or prior complications.

2. Laparoscopic Surgery

Laparoscopic (minimally invasive) surgery uses several small incisions and a camera to guide the procedure. The surgeon performs adhesiolysis and creates an intestinal anastomosis with specialized instruments. This method typically results in less pain and faster recovery.

3. Robotic-Assisted Surgery

Robotic surgery is an advanced form of minimally invasive surgery that provides enhanced precision, flexibility, and 3D visualization. It is particularly helpful in complex pelvic cases.

4. Hand-Assisted Laparoscopic Surgery

This hybrid approach allows the surgeon to insert a hand through a small incision while still using laparoscopic tools. It can improve control in more challenging cases.

5. Stapled vs. Hand-Sewn Anastomosis

The bowel reconnection (anastomosis) may be performed using surgical staplers or hand-sewn sutures, depending on anatomy and surgeon preference.

Each method is selected to balance safety, effectiveness, and recovery outcomes for the patient.

The operation typically begins with an incision around the stoma site, where the bowel exits the abdominal wall. The surgeon carefully dissects the surrounding tissue to mobilize the stoma and separate it from the abdominal wall. This process requires precise surgical technique because the stoma has developed adhesions to nearby tissues during the time it has been in place. These adhesions must be carefully released through adhesiolysis (incision and removal of scar tissues causing features to stick together), to free the bowel without causing injury.

Once the bowel segment is mobilized, the surgeon identifies the proximal and distal ends of the intestine that were previously divided during the initial ostomy surgery. If necessary, a small portion of the bowel may be resected (removed) to remove scar tissue or ensure healthy edges for reconnection. The two ends of the intestine are then surgically joined through a procedure called an anastomosis (reconnection of the ends of the tubes of the bowel or intestine). This reconnection may be performed using surgical sutures or stapling devices, depending on the surgeon’s preference and the patient’s anatomy.

There are several types of intestinal anastomosis, including end-to-end, side-to-side, and end-to-side configurations. The chosen method aims to restore normal bowel continuity while minimizing tension on the connection. After the anastomosis is completed, the surgeon carefully checks the site for hemostasis (control of bleeding) and may test the connection for leaks by introducing air or fluid into the bowel.

Once the intestinal continuity has been restored, attention returns to the abdominal wall. The opening where the stoma previously exited the body is closed in layers. The fascial layer of the abdominal wall is sutured to provide structural support, and the subcutaneous tissue and skin are then closed, sometimes leaving a small area open for drainage to reduce the risk of infection.

Immediately After Surgery

After surgery, the patient is transferred to a recovery area where vital signs and postoperative status are closely monitored. In the early postoperative period, the digestive system may take time to resume normal activity, a condition known as postoperative ileus (a temporary cessation of bowel motility – the bowels aren’t moving normally).

As bowel function returns, patients gradually progress from clear liquids to a regular diet under medical supervision.

An Encouraging Note

Ostomy reversal surgery is generally considered less extensive than the original (likely emergency) operation that created the ostomy, but it is still a significant abdominal procedure. Most patients find the reversal surgery to be almost easy compared to the condition that originally resulted in their stoma. They are healthier, stronger, and their body is more able to rebound and heal from the surgery.

Careful surgical technique and appropriate postoperative management are essential to reduce complications such as anastomotic leak (leaks at the join locations), infection, or bowel obstruction (often caused by fecal matter getting stuck in a narrowed portion of the bowel, or on scar tissue). With successful healing, the surgery restores the natural pathway for digestion and elimination, allowing patients to transition away from the ostomy appliance and return to more typical bowel function.