Assessing Colorectal Care Capacity at an Urban Tertiary Hospital in Ghana

Background: The burden of colorectal diseases continues to rise in Ghana. However, building a surgical workforce to address these diseases has been hampered by the lack of a colorectal specialty training pathway. To address this gap, the first colorectal surgery fellowship in Ghana was established in July 2023. Objective: This study aims to identify strengths and gaps in colorectal care delivery prior to fellowship implementation by assessing relevant infrastructure, resources, and case volume at a Ghanaian teaching hospital. Methods: Data on surgical infrastructure and human resources were collected at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Retrospective, de-identified data were collected on all colorectal procedures performed at KBTH from January 1, 2022, to December 31, 2022. Cases were categorized by common anorectal, abdominal, and endoscopic procedures. Findings: All surgical infrastructure and human resources were always available during the study period, except for immunohistochemistry services. 2,992 colorectal procedures were performed, including 173 anorectal procedures, 167 abdominal procedures, and 2,652 endoscopic procedures. The three most common colorectal surgeries performed were segmental colectomy (n = 76), excisional hemorrhoidectomy (n = 64), and stoma creation/management (n = 52). Some common colorectal services were not provided, including banding of internal hemorrhoids, seton placement for perianal fistulas, rectopexy for rectal prolapse, and pelvic floor evaluations. Conclusions: There is a need for colorectal-specific surgical training and infrastructure in Ghana. KBTH is well-equipped with the resources to support growth of the newly established colorectal surgery fellowship, which will expand colorectal services available for Ghanaians.