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Jan 15, 2025

Experiences with Colostomy Reversal at an Older Age

This topic revolves around an 82-year-old who is considering the possibility of reversing her colostomy. She is currently managing her stoma, affectionately named "Stella," quite well and is enjoying a good quality of life. However, she is curious about the experiences of others who have undergone a reversal, both the successes and the challenges, to understand how it might impact her life.

Here are some insights and advice shared by others:

1. Many people believe in the saying, "If it isn’t broken, don’t fix it." Some individuals in their early 80s have chosen to keep their stomas because they feel well and want to avoid another major surgery, hospital stays, medications, or potential complications.

2. The decision to undergo a reversal is highly personal. It's important to educate yourself thoroughly and base your decision on your personal priorities, overall health, and how much risk you are willing to take.

3. A positive experience shared was from a 63-year-old man who had a colostomy for 7 months due to diverticulitis. He underwent a reversal over a year ago and has no regrets.

4. On the other hand, there are negative experiences too:
- One person had an ileostomy reversal that led to another obstruction within 8 months and was relieved to return to a permanent stoma.
- Another individual disliked the bag, opted for reversal, experienced debilitating symptoms for a month, and then had surgery to reinstate the ostomy, which improved their condition.
- A 69-year-old, two weeks post-loop-colostomy reversal, reported significant abdominal pain, slow wound healing, and skin irritation, advising caution if current stoma management is satisfactory.

5. If you have a complicated medical history, it might predict a complicated reversal. One person’s surgeons warned of likely complications, leading them to stay with the ostomy after consulting a specialist.

6. A study from the U.S. Veterans Affairs on elective ostomy reversal for diverticular disease showed:
- 54.2% of 751 veterans underwent reversal, with a median time to reversal of 5 months.
- The overall complication rate was 23.1%, with surgical-site infection being the most common at 9.1%.
- Factors that lowered the likelihood of reversal included increasing age, hypertension, and higher ASA classification.
- Reversals done 4.6 months or more after creation had 3.4 times higher odds of complications.
- There was no significant difference in complication rates between colostomy and ileostomy reversals.

7. Regarding hernias, one person developed a parastomal hernia 18 months post-ostomy, had it repaired promptly, and is doing well. Regular monitoring and timely repair can help maintain quality of life with an existing stoma.

8. Common themes across responses include:
- A well-managed stoma can provide a quality of life that may outweigh the uncertain benefits of reversal.
- Reversal surgery is not mandatory; personal comfort, existing health conditions, and lifestyle goals should guide the decision.
- If considering reversal, seek surgeons experienced in complex cases and prepare for possible extended recovery times.
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