The separation of the conjoined twins at the head at the Greater Accra Regional Hospital; the correction of a congenital limb malformation in a five-month-old baby at the Komfo Anokye Teaching Hospital in Kumasi and the cardiac catheterisation surgery on three children with various heart complications at the University of Ghana Medical Centre (UGMC) marked an epoch in the medical field in Ghana.
The outcomes of these daring ventures do not refin Ghana.
At the centre of these wonder surgeries are Ghanaians, who have mastered the skill of handling blades and needles to bring relief and hope to their patients.
Angel of hearts
Prof. Nana Akyaa Yao, described as a “heart angel”, undertook that historic procedure on the three children with different health complications within two hours at the UGMC, with support from Global Heart Care.
Cardiac catheterisation is a procedure in which a thin, flexible tube (catheter) is guided through a blood vessel to the heart to diagnose or treat certain heart conditions such as clogged arteries or irregular heartbeats.
Using the Philip Asurion 7 technology for the first time in Ghana, the surgeons conducted a successful procedure which required that the patients, depending on their conditions, spent very short times at the hospital, getting discharged after three days of undergoing surgery.
Prof. Yao, the only paediatric cardiologist in Ghana, talking about the feat, said cardiac catheterisation surgery was the safest heart surgery with few complications because the patient would not be cut open for the procedure.
She explained that the procedure involved accessing the heart through blood vessels in the legs of patients and reaching it with tiny wires, then identifying and dealing with the problem.
While touting the amazing impact of this particular procedure, she said limitations to such surgeries were medical and infrastructure deficits.
At the Komfo Anokye Teaching Hospital (KATH), a Senior Specialist in Trauma and Orthopaedics, Dr Dominic Konadu-Yeboah, led a team of surgeons, anesthesiologists, paediatricians and nurses in a remarkable six-hour surgery to repair a complex congenital limb malformation in a five-month-old baby.
The baby, delivered via caesarean section at a district hospital, was referred to the KATH four hours after birth due to polymelia, an abnormality where supernumerary limbs are attached to a segment of the body.
Polymelia is a rare limb malformation occurring in approximately six per 10,000 live births, with only a few cases reported in the lower limbs. Its pathogenesis is diverse, including instances where identical twins in the womb fail to separate completely during baby formation. When the extra limbs are attached to the pelvis, it is referred to as pyromelia.
After five months of meticulous preparations and pre-operative investigations involving Computer Tomography (CT), Magnetic Resonance Imaging (MRI), echo and ultrasound scans to detect any other associated abnormalities, the complex surgical repair operation took place on February 20, 2023, lasting nearly six hours.
Dr Konadu-Yeboah reported that the immediate and intermediate postoperative periods had been successfully managed without complications and the baby was steadily recovering as anticipated.
Additional minor procedures and surgical interventions will be performed to fully restore normal functioning of the baby.
Conjoined twins
Though rare in Ghana, the separation of the conjoined twins was not entirely new in Ghana. Indeed, the first of such procedures was undertaken in 1999 when Dr Winfred Mensah Hodasi led a team to separate two babies who were conjoined in the abdomen.
What made this latest one complicated and a first was that the babies were joined at the head.
After months of careful planning, preparation and collaboration, the technical team of specialists, from all over the country with international medical specialists led by Prof. Samuel Kaba, successfully performed the surgery to separate the twins on November 28, 2022. Sadly though, one did not survive and the survivor now requires additional surgeries to recover fully.
The conjoined twins were delivered at Nsawam on March 30, 2021 but were referred to the Greater Accra Regional Hospital for the medical intervention to separate them.
Prof. Kaba said globally, in the last 100 years, only 72 of such very complex procedures had been done, with only two survivors, which included the Ghana case.
He described the feat as a milestone, showing how robust the country’s healthcare system was becoming.
“Two years ago as a nation, we embarked on an unprecedented journey to separate the Bansah twins. They were conjoined at the head (craniopagus) and classified as one of the most complex and complicated type (vertical type III).
“We set out to successfully separate them, hoping for the best case scenario where both twins would survive but knowing fully well that we could lose one or both since they shared vital brain tissue and blood vessels,” he said.
“It was also a possibility that one or both of them surviving could suffer some degree of brain injury and disability. In the course of this journey, we have come too far, we have learnt and seen so much, but still have a lot to learn and do. The morale and teamwork of our medical personnel have grown, with more courage to undertake complex medical surgeries and procedures.
“The separation process involved a total of nine major surgeries, the first of which was on December 6, 2021. Total internal separation (neurovascular and brains) was eventually achieved on the November 28, 2022.
“However, there was the need for an emergency total physical separation on December 1, 2022, because twin 1 (Elijah), who had been battling heart failure, suddenly decompensated and suffered a cardiac arrest. He was successfully resuscitated but suffered a second cardiac arrest while being prepared for the emergency separation.
“Resuscitation was not successful and we sadly lost him at this time. Needless to say, this was a big blow to us all. But we were determined to do all we can to save the second twin,” he said.
Logistics
Underpinning all these great interventions — a mixture of knowledge and skill, collaboration and the God factor — are equipment or logistics.
These are not ordinary procedures and thus require the right tools and environment in the surgical theatre to make it happen.
For instance, to be able to successfully carry out the separation, some sophisticated equipment, including a neurosurgery set consisting of a nerve hook, scalp clip sterile system and Layla retractor, had to be shipped in from abroad that cost millions of dollars.
Similar modern technological equipment were also needed for the other surgeries.
Prof. Yao called for investment in infrastructure and training to improve cardiac paediatric training.
“Indeed, training and skills are very important; we need to have the facilities to train many more specialists and equally important is having the equipment for the necessary intervention.
“That is the topmost priority when it comes to such interventions,” Prof. Yao said.
It is possible
Thanks to technology and availing themselves, Ghana has largely moved away from relying on foreign expertise to now having indigenous specialists leading the charge.
Professor Kwabena Frimpong Boateng, the renowned cardiologist, the first black to be trained as a cardiologist and the first African and Ghanaian heart transplant surgeon, successfully conducted heart surgery in Hannover, Germany, in 1987.
He would go on to also become the first to perform an open-heart surgery in Ghana using the heart-lung-machine in 1992 after he trained some doctors and set up the present National Cardiothoracic Centre to ensure that all the logistics needed were provided at the centre.
Today, it has become a centre that serves others beyond Ghana.
In 2018, two surgeons, Dr Obiri Yeboah, a craniofacial surgeon and Dr Frank Nketia Boakye, a neurosurgeon, undertook the first craniofacial surgery Ghana on a two-and-a-half-year-old girl who had a complex facial deformity known medically as frontonasal encephalocoele.
Craniofacial surgery is a surgical speciality that deals with congenital and acquired deformities of the head, skull, face, neck and associated structures. It is a highly specialised procedure and rare, with few specialists in the world.
When Dr Hodasi led a team of specialists to perform the surgery to separate the siamese twins team it was considered a medical breakthrough in Ghana because it was the first in the country. The then babies, Lydia and Linda Awui in 2021, met with Dr Hodasi.
The now retired surgeon described the achievement as an incredible experience in his lifetime, as some many years back, it was impossible to separate Siamese twins, as most of them died before birth, with some also dying few hours after birth.
He also believes that technology and advancement in medicine makes it possible to have such major, complicated surgeries in Ghana, with the procedure spearheaded by Ghanaians.
“Ghanaians are known to be meticulous and among the best-trained in the profession. What is required is the facilities and logistics to work as they should,” he said.
While the outbreak of the COVID-19 pandemic exposed Ghana’s challenges in the healthcare system and the need to invest in medical facilities and specialists in the country, these latest achievements by the surgeons further highlight just how important it is to pay attention to meeting this need, particularly for the sake of the ordinary people who may not have what it takes to travel abroad to seek medical help.
