Closure of Ileostomy

What is closure of ileostomy?

When you had your bowel surgery — most commonly a low anterior resection for rectal cancer — a temporary loop ileostomy (stoma) was likely created at the same time. This stoma diverts stool away from the new join (anastomosis) in your bowel while it heals, protecting it from the pressure and bacteria that stool carries. Once the join has healed fully and your body has recovered, the stoma can be closed.

Closure of ileostomy is generally a shorter and lower-risk operation than the original surgery. Most patients are eagerly looking forward to it — getting rid of the bag is a significant step forward.

When is the ileostomy closed?

Closure is usually planned 8–12 weeks after your original bowel surgery. Before Mr Nguyen proceeds, he needs to check that your bowel join has healed properly. This is done with either a gastrografin enema (a special X-ray dye is passed into the bowel through the back passage while images are taken) or a flexible sigmoidoscopy (a short camera look into the lower bowel). These tests confirm:

• Your bowel join has healed and is not leaking
• There is no narrowing at the join that could cause a blockage
• The bowel below the join is open and healthy

If you had chemotherapy after your bowel surgery, the reversal is usually delayed until your treatment is finished and your blood counts have returned to a safe level — typically around 4–6 months after the original operation.

How is it performed?

Closure of ileostomy is done under general anaesthetic (you are fully asleep) and takes approximately 45–90 minutes.

Peristomal incision

An oval-shaped incision is made around your stoma, freeing it carefully from the skin. Both loops of bowel that make up the stoma (the active loop that stool comes through, and the quiet loop below) are gently drawn back inside your abdomen. The bowel ends are trimmed back to fresh, healthy tissue.

Anastomosis

The two bowel ends are then joined back together — this join is called the anastomosis. Mr Nguyen uses one of two methods depending on your bowel:

• Stapled anastomosis — the most common approach; a stapling device creates a wide, secure join that is less likely to narrow over time
• Hand-sewn anastomosis — used in some situations where a stapled join is not suitable; equally reliable when done well

Wound closure

The abdominal muscle and skin are closed in layers. The skin is usually closed with dissolvable stitches and covered with a waterproof dressing. In some patients — particularly where there was contamination around the stoma site — the skin may be partially left open and allowed to heal gradually from the inside out. This takes longer but actually reduces the risk of infection.

Before the operation

• A gastrografin enema or flexible sigmoidoscopy to confirm your bowel join has healed properly — Mr Nguyen will arrange this before your operation date is confirmed
• You will be asked to have only clear fluids for the 24 hours before surgery
• A full bowel preparation (laxative) is not routinely needed for this operation
• Empty your stoma bag on the morning of surgery before you leave home
• If your stoma has been producing a very high output of fluid, it is important that you are well hydrated and that any low salt levels (electrolyte imbalances) have been corrected before the operation — your GP or Mr Nguyen's team will check this at your pre-operative appointment

What to expect on the day

• You will be admitted on the morning of surgery; a drip (IV cannula) will be placed and antibiotics given before you go to theatre
• The operation takes approximately 45–90 minutes under general anaesthetic
• You will spend 1–2 hours in the recovery room before being transferred to the ward
• A urinary catheter (a soft tube to drain your bladder) is placed during the operation and removed the following morning
• You will start with small sips of water the same day as your surgery, advancing to free fluids and then food as your bowel wakes up
• Bowel sounds (the gurgles and rumbles that tell us your bowel is moving again) typically return within 24–48 hours; your first bowel motion usually happens within 1–4 days after surgery

Recovery

In hospital (2–4 days): Most patients are eating and drinking normally by day 1 or 2. Pain is well managed with paracetamol and anti-inflammatory tablets — strong opioid painkillers are rarely needed beyond the first day. You will be ready to go home once you are eating comfortably and your bowel has moved.

At home:

• Weeks 1–2: Your wound will be checked at 7–14 days. Your bowel movements may be very frequent, loose, and unpredictable at first — this is completely normal. Your small bowel has been "resting" for months while diverted, and it needs time to adapt to carrying stool again.
• Weeks 2–4: Bowel frequency gradually settles. Starting with lower-fibre foods (white bread, white rice, pasta, eggs, lean chicken or fish) helps slow things down. Gradually reintroduce fruit, vegetables, and wholegrains over a few weeks. Aim for at least 2 litres of fluid a day — this is important.
• Weeks 4–6: Most people are back at work and driving by this stage. Avoid lifting anything heavier than 5 kg for 6 weeks to protect the wound and abdominal wall.
• Longer term: The reversal itself does not change the underlying bowel habit caused by your original rectal surgery. If you had a low anterior resection, you may continue to experience symptoms of low anterior resection syndrome (LARS) — things like going more frequently, urgency, or needing to go several times in a short period. This is related to the original surgery and generally improves slowly over 12–24 months. A pelvic floor physiotherapist and a dietitian can both help significantly.
• A post-operative review with Mr Nguyen is routinely arranged 2–6 weeks following your procedure, with timing depending on the type of operation — this review is provided at no charge

Risks and complications

Ileostomy closure is a lower-risk operation than your original bowel surgery, but like any procedure it carries some risks — and it is important you know about them:

Common

• Wound infection — affects 5–15% of patients. The stoma site is naturally colonised with bowel bacteria, which makes wound infections more likely here than after a clean incision elsewhere. Most are treated with antibiotics and wound care and heal well.
• Slow return of bowel function (ileus) — your bowel can take a few extra days to "wake up" and start moving again, requiring you to stay on fluids for longer. This is common, settles on its own, and is not dangerous.
• Loose and frequent bowel motions — very common in the first 4–8 weeks; almost always settles gradually

Less common

• Anastomotic leak — the join at the reversal site breaks down, occurring in fewer than 2% of cases. It may cause localised infection or, rarely, a more serious infection in the abdomen. If this happens, it is treated with antibiotics, a drain, or occasionally a further procedure.
• Small bowel obstruction (blockage) — scar tissue (adhesions) from your original surgery or from the reversal itself can occasionally cause a blockage in the bowel. Many cases settle without surgery; if the blockage is caused by a tight band of scar tissue, a keyhole operation to release it may be needed.
• Hernia at the stoma site — in about 5–10% of patients, a hernia develops at the spot where the stoma was. Most are small and do not need treatment; occasionally they need repair.

Frequently asked questions

Patient guides on this topic

Articles written for patients and their families — to help you understand what you are experiencing and what to expect.