About Your Surgery
This guide will help you prepare for your ileostomy closure surgery at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.
An ileostomy closure is also known as an ileostomy reversal. When you had surgery to remove a portion of your colon or rectum, your surgeon created an ileostomy to allow the anastomosis (the place where your surgeon reconnected your bowel) to heal. Now it’s time to reverse the ileostomy so that you can go to the bathroom in the usual way. Your ileostomy closure surgery is usually done through your stoma (see Figure 1). It is possible that your surgeon will perform the reversal through an additional incision (surgical cut), but that is rare. After surgery, you will have a small wound where the ileostomy used to be. This wound heal in about 4 to 6 weeks. You will need to change the bandage on this wound every day. While you’re in the hospital, your nurse will teach you how to change the bandage and give you the supplies you’ll need to do it at home.Back to top
Before Your Surgery
The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
You and your healthcare team will work together to prepare for your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medications to help prevent them.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications, including patches and creams.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you want to quit, call our Tobacco Treatment Program at 212-610-0507. You can also ask your nurse about the program.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you may have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.
Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
Your nurse practitioner will talk with you about which medications you should take the morning of your surgery. To help you remember, we’ve left space for you to write these medications down in the “Take Your Medications” section of this guide. It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you are taking, including patches and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Health Care Proxy
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy form or to learn more, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.
Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, please read How to Use Your Incentive Spirometer, located in the “Additional Resources” section of this guide. If you have any questions, ask your nurse.
Try to do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.
Eat a Healthy Diet
You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet, talk to your doctor or nurse about meeting with a dietitian.
Stop Taking Vitamin E
If you take vitamin E, stop taking it 10 days before your surgery, because it can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
This is a good time to stock up on clear liquids to drink the day before your surgery. For a list of clear liquids that you can drink, please see the information under “1 Day Before Your Surgery.”
Stop Taking Certain Medications
If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Stop Taking Herbal Remedies and Supplements
Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about if you should continue. For more information, read Herbal Remedies and Cancer Treatment.
Watch a Virtual Tour
This video will give you an idea of what to expect when you come to Memorial Sloan Kettering ’s main hospital on the day of your surgery.
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), located in the “Additional Resources” section.
To reduce your risk of infection, avoid shaving or waxing your abdominal area.
Follow a Clear Liquid Diet
You will need to be on a clear liquid diet 1 day before your surgery. Examples of clear liquids are listed in the table below. During your bowel preparation:
- Do not eat any solid foods.
- Make sure to drink plenty of liquids other than water, decaffeinated black coffee, and decaffeinated tea. Try to drink at least 1 (8-ounce) glass every hour while you’re awake.
Do Not Drink
Any products with any particles of dried food or seasoning
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm the evening before your surgery, please call 212-639-5014.
On the day of your surgery, go to the main hospital at 1275 York Avenue between East 67th and East 68th Streets. Take the B elevator to the 6th Floor to the Presurgical Center (PSC).
Go to bed early and get a full night’s sleep.
Do not eat or drink after midnight.
Take Your Medications
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Two hours before your scheduled arrival time, drink the Clearfast® carbohydrate drink your doctor or nurse gave you. After you finish the Clearfast, do not eat or drink anything else. This includes water, hard candy, and gum.
- Do not put on any lotion, cream, deodorant, makeup, powder, or perfume.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook, at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- If you wear contact lenses, wear your glasses instead.
What to Bring
- Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can accommodate this swelling.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- A CD player and CDs or an iPod, if you choose. However, someone will need to hold these items for you when you go into surgery.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- Your incentive spirometer, if you have one.
- If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Parking When You ArriveParking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once You’re in the Hospital
You will be asked to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar names may be having surgery on the same day.
Get Dressed for Surgery
You will be given a hospital gown, robe, and nonskid socks.
Meet With Your Nurse
Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them. Your nurse will give you medications to help prevent you from getting nauseous and manage your pain after surgery.
Meet With Your Anesthesiologist
He or she will:
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia (medication to make you sleep) you will receive.
- Answer any questions you may have about your anesthesia.
Prepare for Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery located in the “Additional Resources” section.
You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.
Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia during your surgery.
Once you are fully asleep, a breathing tube will be placed through your mouth into your windpipe to help you breathe.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
When you wake up after your surgery, you will be in the Post Anesthesia Care Unit (PACU). You will stay there until you are awake and your pain is under control. Most people return to their room after a few hours in the PACU, but some will need to stay in the PACU overnight for observation.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. After your stay in the PACU, you will be taken to your hospital room in the inpatient unit. There, your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.
- It is important to walk around after surgery. Your nurse will help you get out of bed the day after your surgery. Your activity will be increased until you can walk the halls in the hospital without help. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs and reduce your risk of pneumonia.
- Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, please read How to Use Your Incentive Spirometer, located in the “Additional Resources” section.
Will I have pain after my surgery?
You will have some pain from your wound after your surgery. Your doctor and nurse will ask you about your pain often. You will be given medication to manage your pain as needed. If your pain is not relieved, please tell your doctor or nurse. It is important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.
Will I have pain when I am home?
The length of time each person has pain or discomfort varies. You may have some soreness around your wound, but it usually gets better within a week or 2.
Your healthcare team will give you information about how to manage the discomfort from your surgery. A mild pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil) will relieve your pain or discomfort. If you have pain that is not well controlled taking these medications, call you doctor’s office.
How do I care for my wound?
You will have an open wound where your ileostomy used to be. Before you are discharged you will get supplies and instructions on how to care for it. Your wound should close in 4 to 6 weeks.
You should check your wound every day for any signs of infection until your doctor tells you it has healed. Call your doctor if you develop any of the following signs of a wound infection:
- Increased pain
- Foul-smelling or pus-like drainage from your wound
- A temperature of 101° F (38.3° C) or higher
To prevent infection, clean your hands with soap and water or an alcohol-based hand sanitizer before you touch your wound.
When can I shower?
You may shower without a bandage on your wound when you go home from the hospital. Do not take tub baths or go swimming until your doctor says it is okay.
How do I do Kegel (pelvic muscle) exercises?
You will need to strengthen your anal sphincter muscles by doing Kegel exercises. These muscles help you hold back stool until you get to a toilet. Strengthening these muscles will help prevent incontinence after your ileostomy is closed.
You can do Kegel exercises while you are sitting, standing, and walking.
- Tighten your buttock muscles like you are trying to hold back a bowel movement. Hold this position for 5 to 10 seconds.
- Release and rest.
- Repeat this exercise 10 times, 4 times a day.
How will my bowel function change after surgery?
Your rectum is a storage tank for stool. You had surgery to remove part of it, so now this tank is smaller. This means that it cannot hold as much stool.
If you had radiation therapy, your rectum may have also become stiff. It will not be able to stretch and hold stool as well as before your surgery. This is usually temporary.
For the first few weeks after your surgery, you may have a lot of bowel movements. This is because the lower part of your colon (large intestine) has not been used in a while. It will take time for your body to recover. You may have a lot of small bowel movements because your rectum cannot hold a lot of stool. For 6 to 12 months after your surgery your bowel movements may:
- Be more frequent
- Occur several times an hour, several times a week
- Occur every other day
- Not feel complete; you may have the feeling that you still have to go
You also may:
- Feel a strong sense of urgency to have a bowel movement
- Have trouble telling the difference between having a bowel movement and passing gas
If you have soreness around your anus from frequent bowel movements:
- Soak in warm water 2 to 3 times a day.
- Apply zinc oxide ointment or Desitin® to the skin around your anus.
- Do not use harsh toilet paper. Use a nonalcohol wipe instead, such as a baby wipe.
- If your doctor prescribes medication, take it as directed.
Over time, your rectum will stretch and increase the amount of stool it can hold. This process can take several months to years.
After your ileostomy closure you are at risk for having a bowel obstruction,which means your intestines are partly or completely blocked. The blockage prevents food, liquids, and gas from moving through the intestines in the normal way. The blockage can be caused by food, scar tissue, or a twist in the intestine. Call your doctor if you have any of the following signs or symptoms of a bowel obstruction:
- Tender and bloated abdomen (belly)
- Abdominal cramping
- Nausea or vomiting
- Unable to pass gas or stool
Will medications or supplements help me after surgery?
Your doctor may tell you to take a fiber supplement, such as Metamucil® or Citrucel®, starting about 4 weeks after your surgery. Fiber is both a bulking agent and a laxative.
- Fiber helps stop constipation (not being able to have a bowel movement) by soaking water out of the stool.
- Fiber adds bulk to solid stool, which will stretch your rectum. This stretching takes place over many months, but eventually your bowel movements should become less frequent and less urgent. This will combine all of the small pieces of stool together to create a larger bowel movement. These larger stools will also stretch out your rectum and you will be able to hold more stool. Your rectum squeezes better when it is full.
Start by taking ½ to 1 tablespoon a day, but you take more of it as needed. Drink at least 6 to 8 glasses of water each day because fiber can cause constipation if you’re not drinking enough. If you have bloating and gas, take simethicone (GasX®) as needed.
You may need to take a probiotic supplement. Probiotics are very small organisms, such as bacteria and yeast, that naturally live in your digestive tract. Taking probiotics may help your bowels work better. As your doctor or nurse for recommendations.
If you’re having many bowel movements, your doctor may prescribe medication to slow your bowel down. This may help decrease the feeling that you need to go right away, and may cut down on your number of bowel movements. Your doctor will tell you how much to take and how often to take it. If you do not have a bowel movement for 2 days, contact your doctor or nurse.
Will I need to change my diet after my surgery?
Right after your surgery, you will drink clear liquids, but soon you will be able to eat solid food. Eat 5 to 6 small meals throughout the day. Remember to eat slowly and chew your food well. It’s important you try to maintain your weight.
Foods may affect you differently that before your surgery. Certain foods may make you have bowel movements immediately after eating. You will need to test foods and see how your react to them. You may need to change your diet after your surgery. Certain foods can cause diarrhea (watery, loose bowel movements). Every person is different so there is no way to know which foods will make this happen. During the first few months after your surgery, it may be helpful to keep a food diary. This will help identify which foods may have caused the diarrhea.
You may need to follow a bland diet temporarily if you are having multiple bowel movements a day. On a bland diet, avoid:
- Dairy products, including milk, cheese and ice cream
- Spicy foods
- Fried foods
- Gravies and cream sauces
- High fat deli meats
- Greasy meats, such as sausage and bacon
- Fruit juices
- Sugar-free foods
Foods that can help slow down multiple bowel movements a day are:
- White rice
- Apple sauce
Your dietitian will teach you about eating after surgery before you leave the hospital.
When can I resume my normal activities?
Doing your normal activities is an important part of regaining your strength. However, follow the guidelines below:
- Do not lift heavy objects, strain, or do strenuous exercise for at least 6 weeks after your surgery or as instructed by your surgeon.
- Walking is a good way to increase your endurance.
- Rest as needed, but if you cannot sleep at night, it may be a sign that you are resting too much during the day.
When can I resume sexual activity?
Your surgeon will tell you when you can resume sexual activity.
When is it safe for me to drive?
Do not drive until your surgeon tells you it is okay.
What type of follow-up care will I receive after I leave the hospital?
Your surgeon will want to see you 1 to 3 weeks after you leave the hospital. If you do not have an appointment before you leave the hospital, please call your surgeon’s office to schedule it.
At this visit, your surgeon will check your wound and overall condition. At other follow-up visits, you may have blood tests, x-rays, or colonoscopies.
It is important that you go to all of your follow-up visits after your surgery. You can call your surgeon’s office if you have any questions in between these visits.
What if I have other questions?
If you have any questions or concerns, please talk with your surgeon or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm at the numbers below.
After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the doctor on call for your doctor.
Call Your Doctor or Nurse if You Have:
- A temperature of 101° F (38.3° C) or higher
- Abdominal pain, bloating, cramping, and/or tenderness
- Nausea or vomiting
- The following signs of wound infection:
- Increased pain
- Warmth at the wound site
- Foul-smelling or pus-like drainage
- Trouble passing gas or stool
- Difficulty urinating
- Pain on your wound that is not relieved by pain medication
- Bleeding from your rectum
- Any of the following signs and symptoms of dehydration (not having enough liquids):
- Feeling very thirsty
- Dry mouth or skin
- Loss of appetite
- Feeling dizzy when you stand
- Leg cramps
- Any questions or concerns
This section contains a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.
Call to discuss private room or luxury suite options. If you want to change your room choice after your presurgical testing visit, call 212-639-7873 or 212-639-7874.
Call with questions about anesthesia.
Call for more information if you are interested in donating blood or platelets.
MSK welcomes patients from around the world. If you are an international patient, call for help.
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.
Many people find counseling helpful. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.
Learn techniques to help you feel better about your appearance by taking a workshop or visiting the program online at www.lookgoodfeelbetter.org.
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.
Call Patient Billing with any questions about preauthorization from your insurance company. This is also called preapproval.
Call if you have any questions about the Health Care Proxy form or if you have any concerns about your care.
Call if you have any questions about MSK releasing any information while you are having surgery.
Patients may request private nurses or companions. Call for more information.
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also refer you to community agencies and programs, as well as financial resources if you’re eligible.
If you want to quit smoking MSK has specialists who can help. Call for more information.
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.
Provides travel to treatment centers.
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
A comprehensive resource for education, tools, and events for employees with cancer.
275 Seventh Avenue (between West 25th & West 26th Streets) New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Provides support and education to people affected by cancer.
Provides education and support for those who care for loved ones with a chronic illness or disability.
Free travel to treatment across the country using empty seats on corporate jets.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that is part of the Good Days formulary.
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.
Provides a list of places to stay near treatment centers for people with cancer and their families.
Provides support and advocacy for the LGBT community, including a online support groups and a database of
LGBT friendly clinical trials.
Free cancer legal advocacy program.
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Helps qualifying patients without prescription drug coverage get free or low-cost medications.
Provides assistance with copayments for patients with insurance.
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
- Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Herbal Remedies and Cancer Treatment
- Information for Family and Friends for the Day of Surgery
- How to Use Your Incentive Spirometer