What Is the Procedure for an Ileostomy Takedown?

A temporary ileostomy is used to divert gut contents away from a section of bowel which may have needed to heal following surgery to remove a cancer, for example. Part of the small intestine, or ileum, will have been brought to the surface and opened out on to the skin through a hole known as a stoma, allowing waste matter to be collected in a bag. When it is time for the bowel to be joined back together, the procedure will vary according to the type of ileostomy which was originally created. A simple loop ileostomy takedown can involve cutting two open ends of bowel away from the skin, stitching them back together and returning them to the abdomen. An end ileostomy takedown is more complicated because, after detaching one piece of gut from the stoma, it needs to be joined to a piece of bowel which is inside the abdomen, requiring either an abdominal incision or keyhole surgery to be carried out.

For patients who have had a loop ileostomy, a loop of small intestine will have been pulled out through a hole in the abdomen and cut in half, leaving the two cut ends opening out through the stoma. The ileostomy takedown procedure can only be carried out when the bowel has healed fully and the sphincter muscles that control the passage of feces out of the body are functioning adequately. Patients may practice exercises to tone the anal sphincter muscles in the weeks leading up to surgery. In order to allow swelling and scar tissue to settle, ileostomy takedown usually can not be performed until around nine weeks have passed following the original surgery.

Less than an hour is needed to perform the actual ileostomy takedown, but a stay of up to five days in the hospital may be required. Usually, only liquids are allowed on the day before surgery, and nothing at all after midnight. The surgeon cuts through the skin and down into the abdomen, making a circular incision that goes all the way around the stoma. Both ends of the bowel are then stapled or sewn together and placed back inside the abdominal cavity, with only a small wound remaining in the skin of the abdomen. Following the procedure, it is normal to have only liquids at first and slowly progress to solids on the day after surgery.

Patients who have had an end ileostomy typically need to spend a greater number of days in the hospital, perhaps up to ten, and recovery usually takes longer. The ileostomy takedown surgery may involve reopening the abdominal incision from the original operation to reach one end of the bowel. This can then be joined to the other end of the bowel which has been detached from the stoma. Occasionally, an end ileostomy can be reversed using laparoscopic, or keyhole, surgery techniques.