Ostomy Reversal Surgery & Takedown Recovery

A reversal, often called a takedown, reconnects the bowel and closes the stoma. Stool then passes the usual way again. It applies to stomas that were made as temporary in the first place. The common example is a loop ileostomy made to protect a new join low in the rectum. It diverts stool while the join heals. That matters most when radiotherapy and chemotherapy were given before surgery.

Whether reversal is possible was largely decided at the original operation. Some operations remove the anus and sphincter, as in an abdominoperineal resection. Then the colostomy is permanent by design, and no reversal is planned.

There is no single correct interval. A commonly quoted point is around eight weeks after the original surgery, once the join has healed. In practice, timing depends on several things. Is adjuvant chemotherapy planned? How has your recovery gone? And how does the join look on a check? That check is often a water-soluble contrast enema or a flexible scope. It confirms the join is intact and not narrowed before anything is closed.

Chemotherapy often pushes reversal later. Some teams close the stoma during a gap in treatment. Others wait until it is finished. Neither is wrong. And a delay for a good reason is different from being forgotten.

The reversal is usually a smaller operation than the one that created the stoma. It can often be done through the existing stoma site. The average hospital stay is around three to four days. What you are mainly waiting for is the return of bowel function, and your confidence eating.

Common complications are wound infection at the closure site, and a spell where the bowel is slow to wake up. Less often, the new join leaks. Later, a hernia can develop at the old stoma site.

The part people are least prepared for is not the wound. It is the bowel.

After a low join in the rectum, bowel function is often not what it was. This has a name: low anterior resection syndrome, or LARS. It covers a cluster of problems. You may go often, or go several times in quick succession. You may have urgency, trouble telling gas from stool, and leakage.

It is measured with the LARS score, which runs from 0 to 42. A score of 0-20 is no LARS, 21-29 is minor, and 30-42 is major. Some change in function is very common after low rectal surgery, and major LARS affects a substantial minority. Risk is higher when the join sits lower in the rectum, when chemoradiotherapy was given, and with more advanced nodal disease.

Two things are worth knowing in advance. First, the early weeks after reversal are usually the worst. Function tends to improve over the following months, and up to a year or two. Second, LARS is treatable. It is not always curable, but it is manageable. Loperamide helps. So does adjusting fiber and meal timing. Pelvic floor rehabilitation and biofeedback have a role, usually starting at least six weeks after surgery, with your surgeon's agreement. Barrier creams protect the skin. In some cases, transanal irrigation or nerve stimulation is used. Ask to be referred. Do not assume this is simply how things are now.

Some planned reversals never take place. Sometimes the join did not heal, or has narrowed. Sometimes further treatment or a recurrence takes priority. Sometimes health has changed and the operation no longer makes sense. And sometimes people have lived well with a stoma. They know what bowel function afterwards can be like, and they decide they would rather keep it.

Has reversal been on the table for a long time with no movement? Then it is fair to ask directly. Is this still planned? What has to happen first? And what is the realistic timeframe?

Set up your bathroom and skincare before you come home. Expect to keep a food and symptom diary for a while. Ask for the stoma or colorectal nurse's direct number, because they usually stay involved after the bag has gone. And say plainly if bowel function is affecting your work, or your willingness to leave the house. That is the information that gets you referred to the people who can help.

• Call 911 or go to an emergency department if your abdomen turns rigid and severely painful, or you feel faint with it. A leak at the new join can go downhill fast.
• Call your cancer team at once, day or night, if you are having chemotherapy around the reversal and your temperature reaches 100.4°F (38°C). CDC treats a fever during cancer treatment as a medical emergency, and that lower number applies to you rather than the surgical one below. If you cannot reach them quickly, go to an emergency department and say you are on chemotherapy.
• Call your surgical team the same day if you are not on chemotherapy and your temperature reaches 101°F (38.3°C) or higher, belly pain keeps building despite pain relief, your belly swells, or you are vomiting a lot.
• Call your surgical team the same day if bowel movements start and then stop, or you have not opened your bowels four days after leaving hospital.
• Call your stoma or colorectal nurse within a day or two if the closure wound reddens, weeps, or its edges pull apart, or the skin around your bottom breaks down from going so often.

• MedlinePlus: Large bowel resection — discharge
• United Ostomy Associations of America: Facts About Ostomy Reversals
• NCI PDQ: Rectal Cancer Treatment (patient version)
• Risk factors for LARS after ileostomy reversal (Scientific Reports, 2024)
• CDC: Fever During Cancer Treatment