This topic is about making a decision between having a Hartmann’s procedure reversal, which would reconnect the bowel, or keeping a stoma, which is an opening in the abdomen for waste to exit the body. The person considering this decision is 55 years old and had a colostomy due to perforated diverticulitis in 2022. While life with the stoma is manageable, the thought of a reversal is causing anxiety. Here are some concerns and advice shared by others who have faced similar decisions:

- There are worries about potential surgical complications and long-term bowel issues if the reversal is done.
- There is a fear of future regret if the opportunity for reconnection is declined, especially with plans to retire to Spain in two years.
- Concerns exist about the cancer risk in the retained rectal stump if the stoma remains permanent.
- Family members are concerned about the risks of further surgery and prefer avoiding it.

Advice and insights from others include:

1. Personal outcomes can vary greatly, so decisions should consider previous symptoms, other health conditions, age, lifestyle goals, and the surgeon’s assessment.
2. Some reasons people chose to keep their stoma or regretted a reversal include:
- Chronic incontinence or pain, or rapid bowel transit returned or worsened after reversal.
- Multiple re-operations led to adhesions and ongoing pain.
- Failed reversals sometimes required a second operation to recreate the stoma.
- The sentiment "If it isn’t broken, don’t fix it" was common when the stoma was easy to manage.
3. Regarding cancer risk in a defunctioned rectal stump:
- A meta-analysis of 23 studies showed an overall incidence of 1.3%.
- 0.7% for a defunctioned rectal stump.
- 3.2% for an ileorectal anastomosis.
- Regular surveillance, such as scopes or MRI, is recommended. Some had the stump removed later due to abscesses or sepsis rather than cancer.
4. Positive reversal experiences do exist:
- One person, who had a reversal after 8 months at age 51, described it as an uncomplicated "walk in the park" compared to the original surgery.
5. Published data on 249 Hartmann’s patients showed:
- A reversal rate of 40.1%.
- Better odds for those under 65, with an ASA score of 1–2, and no comorbidities.
- Morbidity was 35%, and mortality was 5%.
- Main complications included surgical-site infection (18%), ileus (7%), anastomotic leak (3%), and others ≤3%.
6. Practical stoma-management tips for those staying with a colostomy:
- Try closed-end pouches changed 2–3 times daily for convenience.
- Extend wear time (up to 7 days reported) by experimenting with different brands or adding an ostomy bonding cement/adhesive.
7. Factors to discuss with surgeons before deciding:
- The exact segment removed (sigmoid, descending, etc.) as it affects stool consistency and gas control after reversal.
- The length of the remaining colon and overall pelvic anatomy.
- Individual ASA score and other risk predictors. The ACS NSQIP risk calculator can estimate complication likelihood.
- Your priorities, such as quality of life with the current stoma versus the desire for natural evacuation.
8. Additional resources cited by members include a previous discussion thread titled "Anxious About My Upcoming Ostomy Reversal Surgery.