This topic is about someone who had an ileostomy surgery and is now considering having it reversed. They were initially told by their surgeon that they wouldn't need a permanent ostomy bag and that their colon could be reconnected later. Feeling misled, they are now looking for a new gastroenterologist and want to know if anyone has had a reversal just because they requested it. Their rectum and anal sphincter are still intact, so technically a reversal is possible, but they are unsure about the other criteria that need to be met. They are seeking advice and information on this matter.

Here are some insights and advice shared by others:

- Reversal is typically considered when your overall health, nutritional status, and disease control make another major surgery safe. Conditions like ongoing weight loss, Crohn’s disease, ulcerative colitis, cancer, radiation damage, or a non-functioning or absent colon can significantly reduce the chances of a successful reversal.

- Many people have reported failed or very challenging reversals, experiencing issues such as:
- Chronic diarrhea, urgency, leakage, incontinence, cramps, and pouchitis.
- Post-operative pain, bloating, infections, adhesions, hernia, and even bowel rupture requiring re-operation.
- Some eventually returned to a permanent ostomy and felt physically better and more liberated afterward.

- Positive experiences do exist but are less common and depend heavily on individual circumstances:
- Those with a healthy, intact colon, such as after diverticulitis perforation or accidental colon injury, often report smoother outcomes.
- A few long-term, satisfied J-pouch users emphasize the importance of meticulous surgical technique and good pelvic anatomy.
- Being younger and not having chronic inflammatory diseases may improve success rates.

- Choosing the right surgeon and facility is crucial:
- Opt for a colorectal surgeon who performs many reversals or J-pouches each week, rather than a general surgeon.
- Large tertiary centers are preferred.
- Interview several surgeons, inquire about their experience and outcomes, and seek at least one second opinion.

- Preparation tips include:
- Achieving your target weight, strengthening your pelvic floor with Kegel exercises, and practicing bowel training or irrigation ahead of time.
- Addressing any comorbidities like diabetes, fibromyalgia, sleep apnea, or hernias, and understanding the added surgical risks.
- Gathering information from support organizations and discussion boards, and reviewing resources for diet, medication, and irrigation guidance.

- Alternative reconstructive options are available if the rectum and anal sphincter remain intact, such as a J-pouch, Kock pouch, or other continent reservoirs, each with their own potential complications.

- Quality-of-life comparisons:
- Some people find living with an ostomy simpler than dealing with frequent, unpredictable bowel movements after a reversal, as it eliminates the need to stay near a toilet and reduces doctor visits or medication needs.
- Others prefer being bag-free despite the higher frequency of bathroom visits.

- Key decision points shared by members include:
1. Conduct thorough research and weigh the pros and cons.
2. Have an open and honest discussion with your surgeon about realistic expectations regarding function, frequency, consistency, and the risk of pouchitis.
3. Be prepared for the possibility that a reversal may not work out, and a permanent stoma could still be the best long-term solution.