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StomaReversal

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Stoma Reversal

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Perhaps you are trying to decide whether to have a reversal?

Stomas are formed for a variety of medical reasons. Differentpeople will have had different types of operations – how muchand which part of the bowel has been removed will vary, somepeople have a loop stoma, others an end stoma.

Although we can’t provide the answer for individual cases…..we can give you information.

Oliver Shihab, Research Fellow at the Pelican Cancer Foundation, describes thedifferent types of stoma and the surgical techniques involved in their reversal from asurgeon’s point of view.

Shelley Biddles and Diana Wilson, who have many years experience as colorectaland stoma care nurses, consider the advantages and possible problems associatedwith a reversal and suggest a simple checklist to ensure you make the appropriatedecision for you.

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oesophagus

stomach

transverse colon

descending colon

sigmoid colon

rectum

anus

ascending colon

small intestine or ileum

liver

large intestinegall bladder

caecum

The Digestion System

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What you need to know about Stoma Reversal

The main reasons that temporary stomas are formed are forcancer of the bowel, inflammatory bowel disease, diverticulitis (acondition where pockets in the bowel wall become inflamedand infected) and injuries to the bowel that mean it has to berested, so that it may heal.

Stomas formed from the colon (large bowel) are calledcolostomies. Those formed from the ileum (small bowel) arecalled ileostomies. In each case they can be either a loop oran end stoma. Please see diagrams opposite.

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End Colostomy

This is usually sited in the left side of theabdomen. With this type of colostomy thecolon (large bowel) is severed and thefunctioning end is brought to the skin. Thedistal end, which leads to the anus, issealed and left inside the abdomen.

Loop Colostomy

To form a loop colostomy a loop of largebowel is brought out usually in the upperabdomen, and then opened and stitchedto the skin. This gives two openings. Theupper, or proximal, limb links up with thestomach and intestines higher up andproduces stool, the other, distal, limbleads to the anus and only produces smallamounts of mucus.

Loop Ileostomy

A loop ileostomy is formed from a loop ofileum (small bowel). Today they are morecommonly used than the loop colostomy,if a temporary diversion of bowel contentsis required, when a join in the bowel (e.g.after cancer surgery for the large bowel)needs to be rested and given time to heal.

End Ileostomy

The end ileostomy is usually sited on theright side of the abdomen. It is morecommonly reserved for those who havehad all or most of their colon removed,usually due to inflammatory boweldisease or multiple polyps of the largebowel.

Illustrations reproduced courtesy of Coloplast

Stoma Reversal

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Loop or end stoma?

Usually the temporary form of stoma isthe loop ileostomy (or less frequently thetransverse loop colostomy). This iscreated when the bowel is obstructed,and needs to be relieved in anemergency or where another sectionfurther down the bowel has had to beremoved.

Occasionally, however, there aresituations in which an end colostomy willbe created on a temporary basis, usuallydone as part of what is known as aHartmann’s procedure. In this operationan end colostomy is formed, and theremaining part of the bowel below thissecurely sealed and left in the abdomen.This is usually carried out foremergencies, such as a blocked bowelwhere there may have been perforationof the bowel or for complications ofdiverticular disease, where there hasbeen infection in the abdomen and it isnot safe to join the bowel upimmediately.

Can it be joined up?

Ideally as many people as possible willbe joined up, but there may be severalreasons why the surgeon looking afteryou is reluctant to do so.

Firstly, to be operated on, no matter howminor the procedure, is never withoutrisk so the doctors must be happy thatyou are fit enough for another operation.

Secondly, the bowel and the analsphincters that control the flow from thebowels need to be working, so thatincontinence will not develop as a result.To help in this assessment the surgeon is

likely to perform a rectal examination,and possibly arrange some further testsof anal tone if there is any doubt.

Overall around 8% of those who havehad a planned temporary stoma forcancer of the rectum end up keeping it asa permanent stoma.

How soon can it be joined up?

It is understandable that people wanttheir normal bowel function restored asquickly as possible, and there have beenseveral studies that have looked at thebest time to do so. After any operation onthe abdomen, there is an inflammatoryresponse to this insult, which results inthe formation of adhesions. Theseadhesions are band-like structures, whichare essentially scar tissue. If they are verydense they can cause considerableproblems for the surgeon, as they canmake some parts of the bowel very hardto get to and operate on safely. These willbe at their worst for the surgeon in theweeks following an operation, so it isadvised that surgery be postponed untilat least nine weeks after the previousoperation. This time allows the adhesionsto settle, the patient to recover from theprevious operation and any swellingwithin the abdomen or stoma site to fullyresolve.

Joining it all up

Closure of a loop colostomy or ileostomyis a relatively simple procedure, and inover 95% of cases does not require anyfurther incisions to be made in theabdomen. A small rim of skin is cutaround the stoma (about 2mm), and theincision is deepened until the abdominalcavity is reached. Once this has happened

www.colostomyassociation.org.uk 7

the bowel and abdominal cavity arechecked, to ensure there is nothing stillattached to the bowel, and the bowel isthen closed - either stitched by hand orstapled together.

Reversal of an end colostomy orileostomy is more difficult, however, asone end of the bowel that is to berejoined is within the abdomen. Thisusually means that the surgeon will haveto open the abdomen via the old scar tobe able to safely access the bowel. As aresult of the increased surgery, comparedto the closure of a loop stoma, there willbe a longer stay in hospital and a greaterrecovery time before normal activities canbe resumed.

There will be some centres that will offerto attempt to reverse an end colostomylaparoscopically (by keyhole surgery), butthis is dependent on the training of thesurgeon. Even if this is attempted it maybe necessary to convert to the openoperation, as the aforementionedadhesions can cause severe problemslaparoscopically. That said, if this type ofsurgery is carried out then it is likely therewill be less post-operative pain and ashorter stay in hospital.

How long in hospital?

This will depend on the type ofoperation: for the closure of a loopcolostomy it will be around three to fivedays and five to ten days for closure of anend colostomy. The surgeons lookingafter you will want to be sure that youcan cope with your bowel movementsonce again, as it is fairly common to passlooser and more frequent stools than youmay have been used to previously. They

will also want to ensure that the areawhere the anastomosis (join) was formedhas not narrowed (strictured) as a resultof scarring, as this can lead to partial orfull blockage of the bowel. If this is thecase then it may be necessary to have thearea stretched, which is normally carriedout using a colonoscope.

What about afterwards?

When you get home, your return tonormal activities will be determined byyour physical condition before theoperation and, again, on the type ofoperation that you have had. It could beat least ten weeks before you are able tolift heavy weights or fully use yourabdominal muscles. Driving will beallowed only when you can perform anemergency stop without any pain, or fearof pain.

Your diet may well require readjustmentinitially, as the time after the reversal canbe similar to the time the stoma wasoriginally formed, with loose bowels andsudden urges to go. It is also possiblethat some people will have developedinflammation of the lower part of colon,which can occur if it is not used for sometime. This can lead to loose stools, withsome bleeding and mucus, but thisusually settles down without need fortreatment.

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What can go wrong?

In any surgery there are risks, butfortunately life-threatening complicationsare rare. As with any surgery there will bethose general complications that canresult from undergoing any surgicalprocedure, which your surgeon willdiscuss with you before your operation.There are also those that are specific tothe reversal of the stoma:

• Ileus – temporary paralysis of thebowel: Sometimes the bowel isslow to start working after surgery,particularly if it has been handledby the surgeon. Disturbances in thesalt balance in your body and somepain medications can also increasethe risk of this occurring. If thishappens the bowel will need to berested, which involves stoppingfood, and taking minimal water.Fluid given via a vein (a drip) isused to replace fluids, and you mayneed a tube down your nose toyour stomach (nasogastric tube)which decompresses the bowel,and helps it to start up again.

• Bowel obstruction – If there is aphysical blockage or problems withadhesions causing a blockageanother operation may be required.Fortunately this type of physicalblockage is rare immediately afteran operation.

• Anastomotic leak – breakdown ofthe join in your bowel: If this issuspected you will be started onantibiotics, and it is likely thatanother operation will be required.However, this can take a controlledform, whereby an abscess forms. Ifthis is the case there may not be

the need for an operation, as it maybe possible to control it withantibiotics and drainage under X-rayguidance.

• Urinary and sexual function – maybe affected temporarily but the riskof this being permanent is higher insurgery to reconnect an endcolostomy, as the nerves controllingthese functions lie in this region.

Hopefully this has given a clearer pictureof the types of temporary stoma used,and the processes involved in theirclosure. Before the operation the surgeonlooking after you has a duty to informyou about the potential risks involved.This is not designed to create doubt andfear, but rather to allow you to make afully informed decision about yourtreatment. However, it should not beforgotten that over 6,000 stoma reversalsare carried out in England every year, andthat the vast majority are successful.

Oliver Shihab MBBS MRCS (Eng)Research RegistrarThe Pelican Cancer Foundation

www.colostomyassociation.org.uk 9

I am happy to beable to tell youthat my husband,

Antonio, recently had acompletely successfulreversal operation. Also weare hoping to move over toSpain within the next six toeight weeks so we will notrequire any further mailingsof Tidings.

Antonio was given a stomain September 2005. Hewent into hospital for repairof an anal fissure and acolonoscopy. A fairly largepolyp was found on thebowel and removed.Unfortunately two days laterAntonio was readmitted tohospital suffering fromperitonitis as his bowel hadbeen perforated when thepolyp was removed. He waspromised a reversal butbecause of his heart attackin 1990 the surgeon wasquite wary of performingsuch a big operation.However, after many visitsto the cardiologist andanaesthetist and varioustests, it was decided he wasfit enough for the operation

and this went ahead at theend of November 2006. Ittook six and a half hours asthere were many adhesionsin the abdomen and thesurgeon decided to giveAntonio a loop ileostomy toallow the colon to healproperly.

He recovered very well fromthis operation and theileostomy was closed on16th May, Antonio’ssixty–fifth birthday!

Apart from suffering fromdiarrhoea for a couple ofdays after the loop stomawas closed, everythingrapidly settled down and hehas not had to take anymedication. He is absolutelydelighted with the quality ofhis life.

B.R.S. (Mrs)

I wouldpersonally adviseagainst a reversaloperation.

I was diagnosed withbowel cancer in October1996. I then hadradiotherapy from 5th to9th December 1996. Onthe 18th December, I hadmy bowel operation andmy colostomy was formed.I was coping really welland feeling fine. Then on15th May 1997, I had areversal.

That was when the troublestarted: my bottom wasred raw and bleeding, Ihad diarrhoea, thenconstipation and problemswith sitting and walking.No one seemed tounderstand. Then finally Iwent back into hospital tohave my colostomyreformed on the 15th May1999. I was told afterwardsit was the radiotherapythat had damaged myinsides. Since then, withhelp from my local stomacare nurses, I have neverlooked back.

Jenny

Readers’ Writes on Stoma Reversal

Here are some extracts from letters published in the original article on Stoma Reversal,first featured in Issue 7 of Tidings Magazine 2007 (for more information about TidingsMagazine and the Colostomy Association please visit our website:www.colostomyassociation.org.uk).

Some letters mention the possible problems which our colorectal surgeon andspecialist nurses refer to in their articles. However, more than half told of successfulreversals. We would like to thank everyone who wrote to tell us of their experience ofstoma reversal.

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I was rushed intohospital insevere pain on

New Year’s Eve 2002. Theyweren’t sure what wascausing the pain, andoperated on New Year’sDay. Imagine my uttershock when four days latercoming out of intensivecare I was told I had acolostomy. I found it veryhard to live with and wasoverjoyed when thesurgeon said I couldconsider a reversal in sixmonths time.I was very afraid, as I hadbeen so ill with the firstoperation, but the thoughtof continuing as I wasmade me determined togo ahead. When I saw thesurgeon regarding theoperation he explained thefailures that can occur andI was worried. My familydidn’t want me to have theoperation but I wasdetermined to go throughwith it whatever the cost.The operation was noteasy, but very successfuland worth everything Iwent through.It is now five years sincemy two operations and Ifeel wonderful. I’mseventy–two but feel morelike thirty-two. You need tothink carefully before youdecide, but if you reallywant a reversal my adviceis go ahead with it. It hascertainly worked for meand, given the samecircumstances, I would doit over again. Believe me,it’s worth it.

D.B. (Mrs)

My husband’sproblems startedwhen he was

sixty-seven with a littlebleeding from his backpassage. A small polyp wasfound in the wall of thebowel and it was decidedto operate before it grewany bigger. He had ananterior resection and partof the sigmoid colon andrectum was removed andhe was given an ileostomy.They found some cancerhad spread through thewall to the lymph nodes,Duke Stage ‘C’, so he had acourse of chemotherapy. ACT scan in October 2005showed that everythingwas OK. We had ups anddowns with the ileostomybut on the whole began tomanage quite well. Myhusband could still enjoyhis hobby of walking.

We tried to find out aboutreversals and went to thelibrary, even looked on theinternet - but nothing. InMarch 2006 he had asigmoidoscopy andeverything was clear. So adate in June was arrangedfor the reversal –twenty–one months afterthe ileostomy was formed.After the reversal, myhusband suffered fromdiarrhoea. Then inSeptember he needed anemergency operationbecause of a blockage anda “transverse colostomy”was formed. Thistemporary loop colostomy

has been hard to deal with,because it is retracted andwe have to use paste toprevent leakage.

The consultant does notknow why the reversalfailed. I wondered if it wasthe length of time beforereversal but he said ‘no’. Heoffered to do anotherreversal but my husbanddoesn’t want to risk thesame thing happeningagain. He could have apermanent end colostomylower down but this isanother major op. The thirdoption, which we havedecided to go ahead with,is to refashion thetransverse colostomy. It hasbeen a traumatic threeyears. We wish he had hisileostomy back but youcan’t go back in time. Hewanted the reversal to beback to normal.

R.S. (Mrs)

www.colostomyassociation.org.uk 11

I had aHartmann’sprocedure done

in 1997 after peritonitisfrom a ruptured bowelcaused by diverticulardisease. When I awokefrom anesthesia my firstquestion was: “Have I got abag?” My world appearedto end and I went back tosleep. However, with thekind and encouragingwords from my stomanurse I realized it wasn’tsuch a bad thing.

In fact I’ve opted to keepmy stoma instead of havingit reversed. My quality oflife is so much better nowthan previously when Ifrequently had an urgentneed to find a toilet. Iwasn’t able to go tofunctions or travel withoutplanning the toilet stops. Infact now I can visit a toiletin much less time thansomeone with naturalfunctions, and, barringaccidents, do so in MYtime, when it suits me.

I developed a largeparastomal hernia and inJune last year had surgeryto repair it with meshreinforcement. After a longrecovery period I am nowquite well and lookingbetter than I have for years.So, anyone having acolostomy, if I canovercome the “horror” socan you. It really isn’t sobad after all.

Fiona

In November2005, without anysymptoms or

warning, I became very ill.Seven days after the initialpain, a CT scan showed thata diverticular abscess hadburst and perforated mybowel. I then hademergency life–savingsurgery which resulted inabout a foot of bowel beingremoved and a Hartmann’sprocedure to form an endcolostomy. I remembersaying: “but I’m aswimmer!” I was assuredthat I would still be able togo swimming with acolostomy.

I was in hospital for nearly amonth, but I gradually madea full recovery and, yes, I didget back to swimming, alsocycling and walking. Myconsultant mentionedreversal when I saw her twomonths after my surgery,but told me to think about itand we would talk about itagain in six months time. Iwrote to the forinformation and also read alot of negative things aboutit and heard stories frompeople who regrettedhaving the reversal.Someone did write a verypositive article about hisreversal in Tidings, so thathelped. I did feel reluctantabout going ahead with theoperation as I felt so welland was coping very wellwith my stoma.

When I saw my consultantsix months later she spent a

long time talking it throughwith me and said that shefelt sure all the negativethings and problems thatwere written about wouldnot apply in my case.However, she did stress thatit was a major operationand told me all the thingsthat could go wrong!Anyway, I decided to go onthe waiting list which turnedout to be seven months. Ihad my operation inFebruary this year. I amsixty-three years old and, asthe consultant said, I was fitand well going into thisoperation, so my recoverywould be much quickerthan my previousemergency surgery. Theoperation was verysuccessful and I said‘Goodbye’ to my stoma afterhaving it for fifteen months.I was in hospital for elevendays. There were some daysafter the operation when Ididn’t feel well and I felt abit low, but only a few.

I am really glad that I hadthe reversal operation andhave made a really goodrecovery. Everything isfunctioning normally again.And, yes, I am back toswimming, cycling andwalking!

J.W. (Mrs)

Stoma Reversal

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People with stomas can leadfull and active lives. However,for many, who have been toldthat their stoma is temporary, astoma reversal cannot comequickly enough. Stoma closureis a very safe and successfulsurgical procedure for themajority of ostomates.Following a period ofrehabilitation, bowel actionreturns to normal or at least anacceptable level of function.However, unfortunately, forsome the reality of stomaclosure may not be as problem-free as they would have hoped.

In this article we intend todiscuss the issues which needto be taken into considerationand how they may affectpostoperative recovery andbowel function, as well aspassing on some hints and tipsthat may be useful following areversal. We will focus on thetwo most common types ofstoma reversal procedures i.e.loop stoma closure and reversalof Hartmann’s procedure.

Undergoing another operation!All stoma closure is performed as aplanned operation and this doesminimise the risk of post-operativecomplications. The surgical team(including the anaesthetist) will assess allpossible risks before the operation andput measures in place to try and preventany problems occurring.

Sometimes it can be quite nerve rackinggoing for further surgery when the lastoccasion may have been an emergencyor, for whatever reason, it may be anunpleasant memory.

Loop stoma closureThis is considered a relativelystraightforward procedure compared tothe original stoma operation andtherefore there is less likelihood ofcomplications arising, although nosurgery is without risks. It involves freeingup the stoma by cutting around where itjoins the skin and rejoining the ends ofthe bowel, thus restoring bowelcontinuity. As this is performed throughthe stoma site it does not usually requirethe abdomen to be re-opened.

Reversal of Hartmann’s procedureThis is a major operation as it involvesopening up the abdomen to reach theportion of bowel that was left inside.There are several aspects that must beconsidered:

• The surgeon will open the sameabdominal incision as before. Theinitial operation may have beenperformed as an emergency andalthough, generally speaking,recovery from any planned surgeryis better nevertheless theconsequences of the procedure i.e.hospital stay and recovery will becomparable with that of theprevious surgery.

www.colostomyassociation.org.uk 13

• Undertaking surgery does notguarantee that the stoma willactually be reversed. If theremaining redundant colon/rectumis too short to successfully join theends of bowel together or if theviability of the redundant section ofbowel is suspect i.e. the bloodsupply is too poor to ensure ahealthy join, the attempt to reversethe stoma will be abandoned.

• It is possible that during thereversal operation a further stomamay need to be formed. If theremaining redundant bowel is veryshort or there are adhesions fromprevious surgery making the re-joining procedure difficult, it maybe necessary to form anothertemporary loop stoma to protectthe new join. This means anotherperiod of time as an ostomate andthen yet another operation tocomplete bowel continuity.

Recovery TimeInpatient hospital stay is getting shorterand shorter with enhanced recoveryprogrammes in place; stoma reversals areeven being performed as day-cases insome centres. However, for most it doesmean a further stay in hospital. This canrange from one or two days for someprocedures to one or two weeks, evenwhen no post-operative complicationshave occurred.

A period of recovery is also necessary.This may vary from a couple of weekswith a loop stoma or laparoscopic(keyhole) reversal up to a couple ofmonths after reversal where theabdominal muscles have been cut again.Time off work may be a concern for somewhen contemplating more surgery.

Whilst hospital stay and recovery areimprecise, the most variable aspect of

rehabilitation is the attainment ofacceptable bowel function. This maymake getting back to “normality”unpredictable.

Function following stoma closureIt will take time for bowel function tosettle into some sort of pattern. This timeperiod will vary from person to person aswill the perception of what is asatisfactory function. During the first fewweeks following stoma reversal, bowelfunction can be erratic.

The following are quite common at first:

• Loose motions (which can swing toconstipation).

• Going to the toilet to pass faecesmore frequently.

• Having some degree of urgencywhen going to the toilet.

• Difficulty determining wind frommotion.

• Sore skin around the back passage(anus).

It is often difficult to predict exactly howproblematic bowel function will be. It isnot usually due to the type of temporarystoma which was formed but more likelydue to:

1. The amount of colon and/orrectum removed.

2. Treatments and the health of theremaining colon and/or rectum.

3. Other previous pelvic surgeryand/or any previous or co-existingpelvic disease.

4. The distance of the join in thecolon/rectum from the backpassage.

5. Capability of anal sphincters.6. Personal satisfaction.

Faeces enters the colon as a liquid andone of the main functions of the colon is

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to re-absorb water back into the body.When a significant section of colon isremoved, the natural consistency of thewaste matter will become more liquid.This may result in more frequent visits tothe toilet and for some may causeconcern regarding control. Exerciseswhich build up and strengthen the analsphincter muscles may prove helpful inpreventing leakage of gas and stool fromthe back passage.

Treatments such as chemotherapy andradiotherapy to the pelvis can delay thereturn to acceptable bowel function. Insome cases the damage may makefunction more unpredictable and forsome it may be painful.

Previous pelvic disease or abdominalsurgery may make stoma closure moredifficult and may also affect long-termfunction.

The use of stapling guns for rejoiningbowel has allowed the surgeon to makea lower join (anastomosis) in the rectumreducing the necessity to remove theback passage and form a permanentcolostomy. However, this may have animpact on bowel function and control.The rectum acts as a reservoir or “holdingarea” for faeces and when a significantportion is removed, coupled with a lowscar line close to the sphincter muscles,the effect can be quite debilitating forsome. This is commonly known asanterior resection syndrome which ischaracterised by the following symptoms:

• Increased frequency• Urgency and a feeling of the needto defecate

• Fragmentation of the motion (afeeling of not having completedpassing faeces)

• Inability to distinguish ‘wind’ frommotion resulting in soiling orpossible incontinence.

This will settle down for most but cantake quite a significant time to do so.Childbirth, age and trauma are just someof the processes that may have adetrimental effect on sphincter control ingeneral. If the initial surgery causes alooser output or reduces the “holding”capacity, control of bowel function canbecome more difficult. Pelvic floor andsphincter exercises to aid bowel controlmay help.

Advice following a reversal

What is acceptable to one may beintolerable to another. Some may expectbowel function to return exactly to howthis was prior to any disease process andsurgery. This will often be unrealistic andunachievable. Also, time to heal must betaken into consideration.

Medication

Anti-diarrhoea medication, softeners, orbulking agents may be required toregulate bowel action and may help toimprove the consistency.

Dietary Advice

Following stoma closure it may take timeto get back to eating a normal, healthydiet. The digestive system may be quiteupset and temperamental. This will meana “settling-in” period for both thestomach and the bowel. During thisperiod it is sensible to limit foods whichcan irritate the gut for example:

• Acidic/citrus fruits e.g. grapefruit,oranges, strawberries or grapes

• Highly spiced foods e.g. curry orchilli con carne

• Big fatty meals• Vegetables with a high “flatulencefactor” i.e. cabbage, Brussel sproutsor onions

• Large amounts of beer or lager

www.colostomyassociation.org.uk 15

Skin care

When bowel movement is loose or ifproblems occur with soiling in the areaaround the back passage, irritation orsoreness may occur. To prevent skinexcoriation, diligent skin care is essential.Washing thoroughly with warm water and“patting” dry with a soft cloth after eachbowel movement is necessary. Applying aprotective cream will help to minimiseany skin problems. However, if this is notadequate contact your stoma care nursefor specialist advice.

Stoma Closure - Your choice

There are an appreciable number ofstomas where the intention was that theywould be temporary, where in fact areversal is not performed. This may bedue to the patient’s personal decision orto advice given by the surgical consultantin charge.

You will hear stories from patients whohave had problems following a reversalor where stomas have had to bereformed and there will always be thosefor whom the outcome wasn't what theydesired. However, for the majority ofpeople who have had stoma reversal, thisis a very worthwhile procedure, resultingin a very successful outcome. The surgicalteam will assess in depth your surgicalcomplication risks, the potential successof stoma closure and the likelihood ofacceptable function before offering you areversal. These facts must be outlinedand discussed with you, prior to surgery.This is called informed consent.

Our article may have focused somewhaton the negative side; however, ourintention is to ensure that people areaware of all the implications of furthersurgery.

We would like all reversals to have asuccessful outcome and have thereforeproduced a simple checklist:

• Make sure you understand whyyour stoma was formed in the firstplace.

• Ask your consultant or nursespecialist to provide you withdetailed information regarding theproposed surgery and the realisticoutcome you can expect in relationto hospital stay, length of recoveryand expected bowel function - bothin the short-term and long-term.

• Consider what your quality of life islike with a stoma.

• Consider what your quality of lifewould be like without a stoma,taking into account all the surgeryand treatment that you have had.

• Speak to people who haveundergone the similar procedure.

• Ask for a written summary of yourconsultant’s plan.

We hope this helps to ensure that youmake the most appropriate “informed”decision for yourself.

Article written for theColostomy Association by:

Shelley Biddles RGN RMNStoma Care 216Education & Training Co-ordinatorNottingham Cancer CentreNottingham University HospitalsNHS Trust

Diana Wilson RGN RMStoma Care 216Stoma Nurse SpecialistColoplast Ltd

Write to:Enterprise House95 London StreetReading RG1 4QA

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E-mail: cass@colostomyassociation.org.uk

Website: www.colostomyassociation.org.uk

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CA013 04v01r01Date of Publication: July 2016

Copyright ©2009–2016 Colostomy Association

Registered charity no. 1113471

How to contact us

This booklet is intended for general information and guidanceonly. The Colostomy Association would like to take thisopportunity to thank:

Oliver Shihab MBBS MRCS (Eng) Surgical RegistrarThe Pelican Cancer FoundationShelley Biddles RGN RMN Stoma Care 216, Education andTraining Co-ordinator, Nottingham Cancer Centre,Nottingham University Hospitals NHS Trust andDiana Wilson RGN RM Stoma Care 216 Stoma NurseSpecialist, Coloplast Ltd for their kind assistance in theproduction of this booklet.

www.colostomyassociation.org.uk