Colostomy Reversal

Colostomy is done when there is a need for a fecal matter deviation in the cases of an anatomical or physiologic malfunction of the whole colon or part of the colon. It can be either done permanently or temporarily. If done temporarily as in the case of after rectal cancer to aid the healing process, the normal gut movement needs to be restored and the colostomy bag removed from the patient

1. When Is a Temporary Colostomy Removed?

There is no particular time interval between when a temporary colostomy is put in place and when it is required to be removed. It strongly depends on the patient factors such as how well the patient is healed from the previous surgery and if the patient requires other interventions that warrant the colostomy bag to remain in place.

2. Indications

Any indication for temporary colostomy needs to be reversed in a few months to give the patient comfort and enable them to fully return to their daily functioning.

3. How is the Procedure Done?

The colostomy reversal procedure depends on whether the initial colostomy procedure was that of the loop or end colostomy. For both, it involves removing the colostomy bag and its associated components then reattaching the upper part of the colon to the lower part of it.

4. Risks

The surgical operation involves bringing together the two parts of the intestines that were parted when creating the colostomy bag. The risks for this procedure include:

There is a chance for acquiring an incisional hernia later on if the repair to the abdominal wall is not well made. Some of the stomas are made onto the abdominal wall and this weakens it over time.
When suturing the parts of the intestines together, anastomotic stenosis may form and also there may be an anastomotic leakage because of the defective repair of the lumen and the associated blood vessels.
Infections at the site of the reversal may ensue because of the contamination of the intestines with the colostomy apparatus as well as that particular surgery to reverse the process.
Because of the heavy manipulation of the intestines during the procedure, there might not be any bowel movement in a couple of days.

5. How you prepare for the surgery

Colostomy reversal takes place about 3 months after colostomy bag placement. The patient should be anticipating this if they have a temporary colostomy bag in place. The patient should be assessed if they are fit for the colostomy procedure. Blood is taken for lab tests and a complete history and physical examinations are performed. Prophylactic antibiotics should be given some few days before the procedure to minimize the risks of infection. Laxatives should be given to clear the intestinal lumen before the surgery so that the surgery can go on well without fecal interruption..Insertion of an intravenous line is required before the surgery so that any drugs or anesthesia can be easily infused into the patient’s body during the procedure as required. if the patient is taking any drugs particularly anticoagulation drugs, they should discuss this with their surgeon/doctor way before the colostomy reversal procedure. Taking the consent before any surgical procedure is paramount.

6. Recovery after surgery

Recovery after the colostomy reversal procedure is normally speedy in most patients with most of them successfully being discharged in 3-5 days. The loop colostomy reversal procedure takes a shorter healing time compared to an end colostomy reversal procedure and associated with lesser complications. Patients are often advised to refrain from eating bulky meals and alcohol intake in a couple of weeks to aid the healing process; small quantities of much more frequent meals are recommended for the recovery period. Because of the constant interfering with the gut during surgery and during the anastomosis, the physiologic functions of the gut might not return within a few days, the patients should, therefore, expect to experience some form of constipation after the colostomy reversal. Laxatives can help alleviate this.Prophylactic antibiotics postoperatively, as well as prophylactic thrombolytic agents, should be used.

7. Outcome after Surgery

Colostomy reversal is a fairly well-tolerated surgical procedure with most patients being able to go back to their daily activities within a couple of weeks without any further complications.

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