This topic is about someone who has been living with a colostomy for 2½ years after emergency surgery due to diverticulitis, which damaged their sigmoid colon. They also experienced kidney failure, which delayed any potential reversal surgery until they received a successful kidney transplant last September. Now, with a functioning kidney and a new routine, they are consulting a colorectal surgeon to consider three options:

1. Full colostomy reversal.
2. Repair of a peristomal hernia.
3. Stoma revision, as one side has flattened, leading to occasional leaks when the output is firm.

They are seeking advice and experiences regarding:

- Reversal after several years with a colostomy, including success rates and the return to regular bowel habits.
- Satisfaction with hernia repair and/or stoma revision, the difficulty of recovery, and whether additional surgery was worthwhile.

After consulting with the surgeon, they discovered that the bulge is not a true peristomal hernia but rather bowel looping under the muscle. Understanding the risks and feeling comfortable with their current situation, they are leaning towards not having further surgery and are grateful for their current quality of life.

Here are some shared experiences and insights:

- Hernia repair experience:
- One person had a parastomal-hernia repair along with a liver resection and found the process straightforward. They recommend getting a second opinion and bringing previous imaging to appointments to avoid unnecessary scans.
- Another person had their hernia repaired during a reversal. Surgeons often leave parastomal hernias alone unless they cause significant issues. Their reversal went well, and their bowel habits returned to normal quickly.

- Factors affecting reversal success:
- The amount of remaining colon is crucial; having more colon generally increases the chances of a successful reversal.
- Colostomy reversals are typically more successful than ileostomy reversals, but individual anatomy and complications are important factors. It's advisable to consult with the surgeon and seek a second opinion.

- Risk assessment:
- Using a surgical-risk calculator can help quantify the risk of mortality and complications based on factors like age, weight, comorbidities, and urgency. For example, two surgeons quoted a 3% death risk for Hartmann’s reversal to one person, which they found unacceptable.
- For transplant recipients on immunosuppressants, infection is the greatest postoperative risk.

- Decision-making philosophy:
- It's important to gather input from multiple sources and then decide what aligns with personal values and lifestyle. Living with a pouch can be a suitable long-term choice for some.