Stoma Reversal

Types of stoma

About when a stoma is created in rectal cancer — on the page “Rectal Cancer Surgery”.

When a stoma can be reversed

Before reversal the following is checked:

• healing of the bowel anastomosis — for a diverting stoma, by endoscopy and/or contrast X-ray study;
• absence of recurrence — based on follow-up tests;
• continence — especially after radiation therapy and a very low anastomosis;
• general condition — after surgery and chemotherapy.

The timing depends on healing and further treatment. If chemotherapy has been prescribed after surgery, reversal is often planned after it is completed; the decision is made together with the oncologist.

Sometimes reversal is not recommended — for example, when continence is poor and the stoma offers a better quality of life, or when the general condition makes the operation too risky. In that case we discuss it openly.

How the operation is performed

A diverting ileostomy is usually reversed through an incision around the stoma, without a large abdominal incision: the bowel loop is freed, joined and returned to the abdominal cavity, and the opening in the abdominal wall is closed.

Restoring continuity after a Hartmann procedure is a larger abdominal operation: the bowel is joined to the rectal stump. When previous operations and adhesions allow it, it can be performed laparoscopically; the approach is chosen after testing. More about this approach — on the page “Laparoscopic Surgery”.

If there is a hernia next to the stoma, it is usually repaired during reversal.

Bowel function after reversal

After stoma reversal, especially after low anterior resection and radiation therapy, bowel movements may be frequent, with urgency and incontinence of gas or stool. After low anterior resection of the rectum, these problems may be a manifestation of low anterior resection syndrome. Symptoms may gradually lessen over the first one to two years, but in some patients they persist longer.

Diet, medications that slow the bowel, and pelvic floor muscle training help. Long-lasting changes are worth discussing with a doctor — they are treated, not just endured.

Risks and complications

Risks are what patients ask about least often, although they are the most important thing to discuss before surgery. The main ones are:

• anastomotic leak — when the bowel anastomosis at the reversal site does not heal;
• temporary slowing of bowel function after surgery;
• wound infection at the former stoma site;
• hernia at the former stoma site later on.

The likelihood of each depends on the type of stoma, previous treatment and your general condition. I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends on the type of stoma and the extent of the operation — ileostomy reversal or restoring continuity after a Hartmann procedure — the approach, the number of days in the hospital and the tests before reversal. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

What documents are needed and how to book

• the operative report of the operation during which the stoma was created, and the discharge summary;
• the pathology report on the removed tumor;
• chemotherapy or radiation therapy summaries, if any;
• results of follow-up tests — CT or MRI discs, endoscopy or contrast X-ray study reports.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.