Reversal of Hartmann's Procedure/End colostomy

Emergency bowel surgery may result in the formation of an 'end' colostomy. The procedure is called a Hartmanns and it involves cutting the bowel in two, one end is secured and left inside the pelvis as a rectal stump, the other is brought out to the left side of the abdomen and shaped into a colostomy. It may be possible to have the bowel rejoined (the stoma reversed), so bowel function is restored. This is a very individual decision and should be discussed with your colorectal surgeon and your stoma care nurse.

How long will I need to wait between stoma formation and reversal?

This will vary from person to person and need to be discussed with your surgeon. As a general rule it is between 3 and 12 months.

How is the operation likely to be done?

The reversal of your stoma is to be done through your abdomen using the same scar as before. The two ends are brought together.

What is the function likely to be after I have had my bowel rejoined?

In order to have a clear idea of this you will need to talk to your surgeon or stoma care nurse to ascertain how much bowel was removed initially and whether the bowel's ability to absorb fluid and thereby solidity of the stool will be affected.

One of the best ways to improve function is to maintain the muscle tone around your anus (pelvic floor). Your stoma care nurse will provide exercises you can do to tone this area. It is likely to be at least six weeks and could be longer before 'normal' function is resumed.

How long am I likely to be in hospital?

This will vary - the surgeon will need to ensure your bowel has begun to function and you are comfortable going home. On average the likely stay could be 5 - 7 days.

What can I expect when I come into hospital?

Bowle preparation will already have been discussed with you by your surgeon and at pre-assessment. If you need to have an enema this will be administered by the ward staff on the morning of your operation.

You will need a safety checklist carried out by ward staff prior to going for your operation.

The consent form and type of anaesthetic

As for any operation, the hospital requires you to sign a consent form. The surgeon will discuss the operation and side-effects with you at clinic prior to you signing this.

You will attend pre-assessment where you will see a nurse and an anaesthetist who will assess your health and fitness for a general anaesthetic.

What problems can occur after an operation?

The bowel can take a few days to work after surgery. Passing wind is a sign that the bowel is starting to work again.

What should I do about my diet after the operation?

The ward staff will give you help and advice on what to eat and you will be given a dietary booklet (Staging Diet). This is the diet you will have followed after your first operation. It gradually increases fibre back into your diet over a few weeks. As a rough guide you should be back to eating normally around 4 weeks after your surgery.

When should I return to normal activities?

As with any abdominal surgery you will need to take care with heavy lifting and stretching for around six weeks. Check with your motor insurance company regarding when you would be covered to drive again. You should return to work and normal socialising, as you feel able but you should check with your GP.

What can I do with my old supply of pouches?

Stoma care nurses will be happy to take back supplies that have not been opened for teaching purposes. All other/open products should be disposed of. Please try to ensure that you only order what you are likely to need before your reversal, as products are expensive on NHS resources.

Your stoma care nurse will visit you whilst you are in hospital after you have had your reversal. On leaving hospital/or once home you will receive a letter formally discharging you from the stoma service.

Your contacts for long term follow up will be as below:

Colorectal / Stoma Service -   tel: 01896 826 832

If your initial surgery was performed for Inflammatory Bowel Disease you should contact your GP or Gastrointestinal Service who are involved in your care should you have any concerns regarding your bowel function.

If your initial surgery was performed for bowel cancer you will have a structured follow up and you should contact your Colorectal Nurses should you have any concerns.