Bowel resection, stoma formation and reversal

A bowel resection is a surgical procedure performed with the patient under general anaesthetic that involves a part of the small or large bowel being removed that is damaged, diseased or blocked. During surgery, the two ends of the bowel are joined together again using surgical staples or stitches. This operation is often suitable for patients suffering from Crohn’s disease, a bowel blockage, colon or rectal cancer, diverticular disease or bleeding.

Laparoscopic (keyhole surgery) or open surgery can be used to perform a bowel resection. During open surgery, one long cut is made along the tummy and surgical tools are used to remove the affected section of intestine. Laparoscopic surgery involves between two to four cuts being made, and a thin tube with a small camera (a laparoscope) on the end of it photographing the area so the surgeon can see it. Then, small surgical tools are passed through the incisions to remove the affected part of the intestine.

Prior to surgery

Laxatives are offered to ensure that the bowels are empty and therefore visible to the surgeon. Sometimes, a surgeon will need to perform a stoma during a bowel resection, usually if there is a problem that could prevent the two ends of the bowel from recovering properly. A stoma is an opening in the skin that allows faeces to pass into a bag. While some stomas are permanent, some are temporary and require a reversal a few weeks after the original bowel resection.

Recovery

Post-surgery, the stitches that were made will dissolve on their own. It is common to feel pain in the abdomen, and patients are usually in hospital for between two to seven days. Pain relief will be administered, and patients are advised on caring for their wound. Open surgery generally takes longer to recover from compared to laparoscopic surgery, but generally, a full recovery is made after six weeks.

Stoma formation and reversal

A stoma can be needed for several reasons, such as a blockage in the colon, rectal or colon cancer, suffering from a disease such as Crohn’s or ulcerative colitis and also, experiencing faecal incontinence. A stoma is an opening through the stomach that is the result of a colostomy, ileostomy or urostomy procedure, an operation that diverts one end of the bowel through the opening. Stomas are connected to either the urinary or digestive system to allow either urine or faeces to leave the body instead of through the usual way of urinating or emptying the bowels.

To create a stoma, surgeons pull part of the small or large bowel onto the skin’s surface and sew it onto an opening in the abdomen. The intestine end empties waste into a pouch attached to the stoma.

Reversal

Sometimes, stomas can be reversed. This only occurs if the surgeon is satisfied that bowel control can be regained, hence removing the need for a stoma. Colostomy and ileostomy reversals are performed in the same way. The temporary stoma is removed, and the two separated ends of the bowel are re-joined.

Other considerations to take on board prior to a reversal include whether the patient is healthy enough to cope well during surgery, if there is any present disease in bowel and/or rectum and if there is enough rectum left intact that a stoma is not needed. Methods of testing a patient’s suitability for a stoma reversal are; a rectal examination to determine whether the sphincter muscle is strong enough, and/or an enema to check there are no leaks and a flexible sigmoidoscopy (an imaging test to check for the presence of ulcers, polyps and any other abnormalities).

Recovery

Usually, a stoma reversal is not performed until at least three months after the creation of the stoma, as this gives enough time for the bowel to have healed. It can be performed laparoscopically or by open surgery. Most patients find that a stoma reversal is less gruelling than their original stoma formation. Following a stoma reversal, heavy lifting should be avoided for six to eight weeks, and to begin with, feelings of tiredness and weakness are normal.

For the first 24 hours post-operation, patients should stick to a liquid only diet. Solids can slowly be incorporated back into a patient’s diet to allow the bowel time to rest.

To find out more or make an appointment with Mr Hornung, please call 0161 495 6148