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Is a ileostomy reversal worth it for a 60-year old geezer?
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Is a ileostomy reversal worth it for a 60-year old geezer?
I had a LAR in Dec 2018 due to rectal cancer. Now my doctor is pushing for ileostomy reversal. I thought it made sense, but after reading comments from the forum, I'm wondering if it's worth it. I don't love my bag, but I don't hate it either. I can manage with it. It scares me to think I could have an accident at any time without the bag. I'm a stand-up corporate trainer and the last thing I need to think about is whether I need to run to a toilet. Maybe as a 60-year old, it's not worth it do this op? Before my LAR and chemo/radio I was stage 3b. Now I/m stage 0. I've had my rectum removed (27cm / 10.6"). Any comments pro/con would be welcome. Just need some advice. ~ Steve
Re: Is a ileostomy reversal worth it for a 60-year old geezer?
The decision to have a reversal is a personal one. A person should keep in mind that the majority of people who have had these kinds of procedures have had good results with them and rarely visit these boards, so it is easy to think that there is a high rate of complications. The success of a reversal depends on the strength of the anal sphincter and the storage capacity of the remaining rectum. You may want to ask your surgeon if any of his patients who have had a reversal would be willing to discuss their experiences with you. Wearing a small pad to prevent soiling would be an option if you did have some leakage and, in my opinion, would be better than having a bag.
My thoughts would be to go ahead with the reversal. In the event it did not produce satisfactory or acceptable results, you could always go back to the bag, or get a K pouch or BCIR which are two procedures that do not require having an external bag.
My thoughts would be to go ahead with the reversal. In the event it did not produce satisfactory or acceptable results, you could always go back to the bag, or get a K pouch or BCIR which are two procedures that do not require having an external bag.
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Bob Webtech
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Re: Is a ileostomy reversal worth it for a 60-year old geezer?
Hi csteven,
Your rectum has been removed but you still have most or all of your colon. If you decide not to reverse your ileostomy, you'll be living indefinitely with a bypassed colon, which will continue to generate mucus that will need to be expelled from your body. And, in fact, there's a high likelihood that the bypassed colon will develop a condition called diversion colitis, which means its lining will become inflamed and secrete some pretty nasty material.
It's true that some people who've had a LAR (low anterior resection) experience problematic bowel function after reversal of their temporary ostomy. As BillV says, this may not be very common. But it's still common enough that it's been given a name: "low anterior resection syndrome" or LARS. Whether it occurs in your case depends on many factors. Bill wrote that it depends on the strength of the anal sphincter and storage capacity of remaining rectum. In your case, if I've interpreted your post correctly, it appears that your entire rectum was removed, so you don't have any remaining rectum. There's still the question whether any anal tissue, especially any part of your anal sphincters, might have been removed. Other factors include possible radiation damage in the anal area. Also, the precise nature of your colo-anal anastomosis, i.e., the reconnection of tissues above and below the resected rectum.
While LARS is a possibility, you probably won't want to live indefinitely with a bypassed colon and its high probability of diversion colitis. So it would seem reasonable to go ahead with takedown of the temporary ileostomy. Then, if LARS turns out to be a big problem, you can get another "bag" but it wouldn't be the same kind of ostomy you have now. Instead of your current temporary ileostomy, which is probably in your lower right abdomen, you'd get a permanent colostomy, which would be in your lower left abdomen and whose output would have consistency closer to normal stool. And the colostomy may be a candidate for irrigation, which may enable you to control when output occurs and avoid having to wear a pouch all the time.
BillV mentioned "K pouch" and BCIR as possible alternatives to the "bag." Actually, those surgeries are intended for cases when the entire colon is removed, as may be necessary for ulcerative colitis or familial polyposis. So they wouldn't apply in your case. And, by the way, although Bill described "K pouch" (which stands for Kock pouch) and BCIR as two different procedures, the BCIR is actually a variant of the Kock pouch, so the term Kock pouch (or "K pouch") can refer to both of them.
Your rectum has been removed but you still have most or all of your colon. If you decide not to reverse your ileostomy, you'll be living indefinitely with a bypassed colon, which will continue to generate mucus that will need to be expelled from your body. And, in fact, there's a high likelihood that the bypassed colon will develop a condition called diversion colitis, which means its lining will become inflamed and secrete some pretty nasty material.
It's true that some people who've had a LAR (low anterior resection) experience problematic bowel function after reversal of their temporary ostomy. As BillV says, this may not be very common. But it's still common enough that it's been given a name: "low anterior resection syndrome" or LARS. Whether it occurs in your case depends on many factors. Bill wrote that it depends on the strength of the anal sphincter and storage capacity of remaining rectum. In your case, if I've interpreted your post correctly, it appears that your entire rectum was removed, so you don't have any remaining rectum. There's still the question whether any anal tissue, especially any part of your anal sphincters, might have been removed. Other factors include possible radiation damage in the anal area. Also, the precise nature of your colo-anal anastomosis, i.e., the reconnection of tissues above and below the resected rectum.
While LARS is a possibility, you probably won't want to live indefinitely with a bypassed colon and its high probability of diversion colitis. So it would seem reasonable to go ahead with takedown of the temporary ileostomy. Then, if LARS turns out to be a big problem, you can get another "bag" but it wouldn't be the same kind of ostomy you have now. Instead of your current temporary ileostomy, which is probably in your lower right abdomen, you'd get a permanent colostomy, which would be in your lower left abdomen and whose output would have consistency closer to normal stool. And the colostomy may be a candidate for irrigation, which may enable you to control when output occurs and avoid having to wear a pouch all the time.
BillV mentioned "K pouch" and BCIR as possible alternatives to the "bag." Actually, those surgeries are intended for cases when the entire colon is removed, as may be necessary for ulcerative colitis or familial polyposis. So they wouldn't apply in your case. And, by the way, although Bill described "K pouch" (which stands for Kock pouch) and BCIR as two different procedures, the BCIR is actually a variant of the Kock pouch, so the term Kock pouch (or "K pouch") can refer to both of them.
Bob Baumel, UOAA discussion board administrator