Colorectal Surgery: Ostomy and Ostomy Reversal

When the Division of Colorectal Surgery prepares for surgery resulting in an ostomy, they also plan for its reversal.

Matt’s Story

In early 2014, Matt Teichman was at his prime, a healthy, single young man (age 27) working at an investment firm in New York and committed to his daily fitness routine. That spring he started feeling unwell and began having symptoms of low energy, weight loss, and occasional pain. Matt put off the colonoscopy his doctor recommended, afraid of what it might reveal. By June, his pain and lethargy had worsened considerably to the point that Matt barely left his house. He had dropped 60 lbs. At that point, Matt said, “The pain was blinding. It was so overwhelming I couldn’t think clearly.”

Having not seen his son for some time, Matt’s father was shocked when he came for a visit. He wasted no time in getting Matt to NYP/Columbia, where the doctors found his colon to be severely inflamed due to Crohn’s disease. He would need surgery to remove a diseased section of his colon.

When he woke from surgery, Matt was both frightened to see an ileostomy bag attached to his body, but simultaneously relieved that he was “no longer in an insane amount of pain, about to explode.”

After his initial repulsion and fear, Matt began learning about his ileostomy bag with the help of Erin Testerman, the colorectal division’s certified wound, ostomy, and continence nurse. With her support, Matt says he “became a pro” at caring for – and living with – his ostomy. It wasn’t always easy; he says he went through a process of losing, and then regaining, his dignity.

Daniel Feingold, MD and P. Ravi Kiran, MBBSAbout four months after his ostomy surgery, Matt’s surgeon, Daniel Feingold, MD, performed a second surgery to reverse the ostomy. Matt has recovered well since then. But going through the challenges associated with having an ostomy changed Matt. He says that once he accepted the ostomy as part of himself, taking care of it became second nature. Initially he didn’t think he’d get to that point of acceptance, but he did. He was able to go out and socialize while he had the ostomy, finding ways to cover the appliance so it was unnoticeable. As he described it, “I learned there are much more important things than appearances.”

Having overcome the challenges of an ostomy himself, he feels very strongly about encouraging and supporting others who may be afraid or discouraged by the prospect. He has helped other patients to learn to care for their ostomies, and he offers this perspective: “It is a process. Once you go through it, things can get back to where they were at. There are worse things in life – I think bad breath is worse than an ostomy. With the right guidance, you can live comfortably. It is not the end of the world.”

Planning for Ostomy Reversal from Day 1

Just as Matt’s surgeon was able to reverse his ostomy, many other patients are able to have theirs reversed as well. According to Dr. P. Ravi Kiran, Chief of the Division of Colorectal Surgery, the colorectal team avoids creating an ostomy if possible, but when it is unavoidable, they plan right from the beginning how they will be able to reverse it within the next six to 12 months. They achieve this goal through careful planning and innovative surgical procedures that require a high level of skill and training. While this approach is not the norm elsewhere, NYP/Columbia is able to reverse ostomies even in some patients who may not be offered such options in other centers. The division offers “end of the road” procedures such as the Turnbull Cutait operation, redo colorectal anastomoses, and sleeve resection for Crohn’s disease that are available at very few centers in the world.

The Turnbull-Cutait procedure may be performed to avoid a permanent ostomy in certain extenuating circumstances.Although surgeons at NYP/Columbia reverse many ostomies after patients recover from surgery, not every patient feels compelled to take advantage of that option. Tannette Brown, a 32-year-old mother of three from the Bronx, gained an ostomy when she had to have a cancerous section of her colon removed in 2014. After surgery and chemotherapy, she grew accustomed to her ostomy bag and moved on with her busy life. Her doctors offered to reverse the ostomy, but her approach was, “Why bother? Why would I want to go through another surgery?” It was only after thinking about swimming at the beach that Tannette changed her mind and decided to go through with the procedure. But like Matt, Tannette grew used to having an appliance and now encourages others to realize they, too, can get along just fine with it.

What is an Ostomy

In some cases, the treatment of cancer, Crohn’s disease, and other serious colorectal conditions requires that patients have portions of their bowel or rectum removed. This may entail creation of an ostomy, a surgically created opening in the abdomen that allows urine or feces (or both) to pass through the body into a bag attached to the abdomen.

Sometimes people may refer to an ostomy as a stoma; a stoma is actually the end of the large or small intestine or ureter that is visible at the abdominal wall.

Different types of ostomies may be created, depending on which segment of the bowel or rectum may need to be removed.

For instance, a colostomy refers to an ostomy created by removing a portion of the colon (large intestine) or rectum, and connecting the colon directly to the abdominal wall. A colostomy may be temporary or permanent, and there are various types of colostomies that may be created. An ileostomy refers to an opening created by connecting the small intestine to the abdominal wall.

Preserving continence

In many cases, a person with an ostomy can retain continence through creation of a valve in the stoma. For example, in a continent ileostomy, surgeons use part of the intestine to create a pouch inside the abdomen, and then construct a valve in the pouch. Patients can insert a catheter into the pouch several times a day to drain waste from the pouch. This option allows patients to control the timing of his or her elimination, and prevents the need for an external appliance (waste bag).

Visit columbiasurgery.org/colorectal to learn more about ostomy and ostomy reversal.