Considering a Stoma Reversal: Seeking Advice and Experiences

Hi all, just waiting on a date for reversal, and am in turmoil whether or not to go ahead. I had perforated diverticulitis in 2022 and had a stoma. I manage fine with my stoma, so I wonder if I should risk possible complications. I am 55 and hope to retire to Spain in 2 years, and I ask myself will I regret the chance of this reversal in later years. My partner and son don't want me to go ahead with it because they are worried. Are there any folks out there who have had a reversal from Hartmann's procedure that might regret it for any reason? Arrrr, minds in turmoil. Also, is it okay to live with a rectal stump? I read something about the possible chance of being more susceptible to developing cancers, which is obviously a worry if I decide not to reverse.

Hello Jonny.
This question has arisen several times in the past and you can read those replies in the 'collections' section at the top of the page.
Making such a decision is very personal and, presumably would depend upon a whole range of circumstances.

I opted for keeping my colostomy, mainly because (despite what the doctors were saying) it seemed obvious to me that the problems (of chronic  incontinence accompanied with pain) would simply return if I had a reversal. 
that decision was a long time ago and I have never regretted it.
Best wishes 
Bill

I'm not saying this is the right way; far from it, it's the worst thing anyone should do to choose which surgery to have or not have. When I was 19, I had the choice of an internal pouch or ileostomy. My head was all over the place; I had no idea what to do, and I was too young and stupid at the time to ask for help. A few things happened in the weeks before surgery, and I flipped a coin to choose. One week before the surgery date, ileostomy won. I'm 55 now, no regrets.

My rectum and anus were left in for about 15 years after surgery before they were removed. Until then, I used to have a scope in my anus every 2 years. After some time, the anus sealed itself up, so I had an MRI scan every 2 years to check all was okay until I had it removed. There is a small risk of cancer, but mine was removed for keep getting abscesses. I had sepsis one too many times, so it was time to get rid of the cause of it.

I got my colostomy because of rectal cancer. The cancer was high up, so they left me with a rectal stump and my anus. I do not believe your risk of cancer is that much greater with a rectal stump than it would be with the rectum attached to your colon. I would not use that as a deciding factor.

I believe I am a candidate for reattachment but have no interest in pursuing it. I haven't had my colostomy very long, but why fix what isn't broken?

From my perspective, I should have never allowed my surgeon to talk me into having a reversal. The reversal was a complete disaster, as I have rapid bowel transit, which means that anything taken by mouth comes out of my ileostomy in around 10 to 15 minutes - and after more than 50 operations [I lost count], I was running to the toilet about 30 times a day.
I was very, very happy after waking up after a 20-hour surgery to learn that 'Mount Vesuvius' was back permanently!!

Also, having so many operations, I quickly learned that the more operations one has, the more adhesions/internal scar tissue the body makes. And adhesions are not fun, and mine cause me a lot of pain.

If you are happy with your stoma, and you have doubts, maybe consider not having the reversal....

I googled what the risk of getting cancer is if you have a rectal stump (mine is only about 4.5 cm in length). I found this on Google:

"Data from 23 of the 24 identified studies was suitable for analysis. The pooled incidence of rectal carcinoma was calculated to be 1.3%. Subgroup analysis showed an incidence of 0.7% and 3.2% for patients with a de-functioned rectal stump and ileorectal anastomosis, respectively."

So I am not planning on worrying about what could happen.

My Ostomy Journey: Keyla | Hollister

I tried a reversal in 2016 against my best judgment, and it didn't work. If I had to do it again, I would have left it alone. They had to bring back my stoma again anyway. I have the stump too and have been living this way for 10 years. Everybody is different, but I don't plan to try the reversal again.

He can only read the collections if a paid member. I could be wrong, but the forums, for example, cannot be read; they can be seen as titles, but not the replies.

Someone correct me if I am wrong. Apologies in advance.

Aren't these the forums? I read them fine, and I'm a free member.

I cannot search the forums for previous topics, but I can manually skim them and read anything I find.

The mantra on this site is everyone is different even though we deal with the same issues. I have a colostomy and chose not to reverse because I am having no problems managing my ostomy, and reversal for me would lead to the same and probably worse complications than my initial surgeries.

I can provide you with the results of 249 patients that undertook a Hartmann Procedure. The study involved 249 patients.

1. 249 patients had the Hartmann's Procedure (HP) performed.
2. In this study, the rate of Hartmann's reversal was 40.1% (100 patients).
3. Younger patients were found to be more advantageous in terms of HP reversal.
4. Patients without comorbidities were more advantageous in terms of HP reversal.
5. Patients with low ASA scores were more advantageous in terms of HP reversal.
6. Patients with ASA 1–2 were more advantageous in terms of HP reversal.
7. The median length of the second surgery was 150 (60–430) minutes for the 100 patients.
8. The median time to stoma closure was 8 (1–45) months.
9. Younger patients, patients with lower ASA scores, and those without comorbidities had a greater chance of closure of the stoma.
10. Significant risk factors are:
    • age
    • ASA score
    • comorbidities
11. Being under 65 years of age was found to be advantageous in terms of Hartmann reversal in this study.
12. In this study, patients with no comorbidities achieved higher rates of Hartmann's reversals than those with one or more comorbidities.
13. In the present study, the morbidity rate of 35% (n = 35) and a mortality of 5% (n = 5) were identified to be associated with Hartmann's reversal.
14. The most common complication after Hartmann's reversal is wound site infection, which has been reported to range from 2% to 41%. The presence of wound site infection has been shown to cause wound dehiscence, incisional hernia, prolonged hospital stay, and increased costs — in these cases, the rate of wound site infection (n = 18) following Hartmann's reversal was 18%.
15. It should not be forgotten that the reversal of Hartmann's colostomy is still a major operation in patients at low risk for the nonreversal of Hartmann's colostomy (permanent); the total complication rate and morbidity are quite high. It should be known that the rate of postoperative complications is high, especially in cases of multiple comorbidities.
16. Complications after reversal:
    • Second operation (Reversal) (n = 100)
    • No complications 60 (60%)
    • Surgical site infection 18 (18%)
    • Ileus 7 (7%)
    • Anastomotic leak 3 (3%)
    • Eventration 3 (3%)
    • Colovesical fistula 1 (1%)
    • Ureteral injury 1 (1%)
    • Pneumothorax 1 (1%)
    • Pulmonary embolism 1 (1%)
17. Deaths after reversal 5 (5%)

In addition to the information provided by the study, talk with your surgeons about whether you are a strong or weak candidate for reversal, talk with your family, assess your comfort level with the ostomy, and don't forget to pray.

You can also look at a previous topic:

Anxious About My Upcoming Ostomy Reversal Surgery

https://www.meetanostomate.org/discussion-forum/viewtopic.php?t=33983

G-Day Jonny,

I have told this story a few times now, but you're new, so here we go again. I had my colon removed and got a J-Pouch 21 years ago, but for 18 years, I had many, many problems, so I got my surgeon to get rid of it, and I now have an ileostomy for the last 3 years, and it is a lifesaver. It is easy to live with, and I am sorry I ever went for a reversal.

Regards, IGGIE

Hello,

I'm assuming you have a colostomy. If so, what kind? Sigmoid, ascending, transverse, descending.

Knowing the colostomy type can give you an idea of what to expect after reversal. Each section of the colon performs a particular function.

Sigmoid colon, for example:

Its function is to expel solid and gaseous waste from the gastrointestinal tract. It has a curving path toward the anus, allowing it to store gas in the superior arched portion, enabling the colon to expel gas without excreting feces simultaneously. So stool is collected here until it's ready to be expelled by the rectum/anus. If you're missing a section of the sigmoid colon and later get reversed, it's possible you'll have soft stools and gas. It depends on how much of this colon was removed and where.

Many people have successful reversals. Do some research about your surgery and colostomy type, and how much of your colon was removed. Knowing these facts will help you work with your surgeon to make an informed decision.

Thank you for this valuable information. The exact procedure was “Laparoscopic Assisted Hartman's Procedure, Open Appendectomy. I am 82 and had the descending sigmoid surgery and appendix removal on 12/16/24 due to a perforated colon from diverticulitis with resultant stoma. I'm unable to determine how much of the colon was removed from the complicated details in the medical procedure notes, but I have 2 different colorectal surgeons' consultations late this March to discuss reversal. I am unsure how to determine skill level or how to assess complication levels.

Though tiring and tedious, I have to empty the bag 2-3 times daily and total replacement 2-3 times weekly. There is occasional diarrhea, but mostly soft stools. General health is quite good, and I am using a treadmill. The thought of continuing these daily cleanings, especially as I get older, is concerning, and yet the number of reversal complications listed by others is also very concerning. I appreciate any and everything you might suggest or comment on.

With a colostomy, I think you can get longer wear time. Ileostomies will probably not get that much wear time. I'm getting 7 days with my setup. I mostly have very liquid output, so I could probably get more with more solid output. You might try different brands or add an additional adhesive to extend your wear time. I use a bonding cement sold as an ostomy accessory.

I use closed-end bags and just change them out 2-3 times a day. Get a sample of closed-end bags to see if replacing the bag is easier for you. Many people use the drainable bags, so it isn't wrong, just a matter of preference.

Hello - I had a reversal of Hartmann's procedure after having my colostomy for 8 months. I was 51 when it was reversed. Mine went great, and it was a walk in the park compared to my original surgery - but that is just my experience... I have no regrets. Best of luck with whatever you decide!

For anyone who needs their ASA score, here's the link:
https://riskcalculator.facs.org/RiskCalculator/
The surgical code is: 44626 - Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (e.g., closure of Hartmann type procedure)

Nice tool, I didn't know about it. Thanks for sharing.