08/01/2026
Doc , I accept all you have said to treat my cancer but I will not accept the surgical procedure you want to perform on me, go and find a better procedure for me. I don’t want to lose my a**s; I will prefer to die with my disease than live with a colostomy (Mr O, 2014). Mr O is alive today.
Faecal incontinence is a distressing condition that evokes significant emotional and psychological stress. This burden is even greater when the incontinence results from removal of the a**s and the creation of a permanent colostomy.
Although colostomy is life-saving, it is often deeply abhorred by patients, many of whom would rather risk death from their disease than live with a permanent stoma. A colostomy is difficult and costly to maintain and is frequently associated with reduced self-esteem, social isolation, and depression.
Earlier surgical treatment for low re**al cancer was radical and brutal, involving removal of the re**um together with the a**s and the creation of a permanent colostomy. This approach was also commonly associated with erectile dysfunction in men. Goligher, a student of Miles who pioneered this procedure, famously remarked that “if after surgery the patient was not impotent, then the patient may not have been cured.” Understandably, this fostered fear among patients, leading many to refuse surgery and ultimately succumb to the disease.
In 2014, open intersphincteric resection of the re**um with preservation of the a**l sphincter was introduced in Ghana, bringing significant relief to patients. Although first described in 1994, the procedure initially gained little acceptance due to poor outcomes. However, with the advent of improved adjunctive therapies for re**al cancer, intersphincteric resection has gained renewed relevance. Many patients with early, curable disease treated using this approach are alive today, living normal lives with good a**l function.
Laparoscopic intersphincteric resection of the re**um represents the contemporary gold standard for the treatment of low re**al cancer. This minimally invasive technique removes the cancerous re**um while preserving the a**l sphincter, thereby maintaining continence and quality of life.
Currently, laparoscopic intersphincteric resection for re**al cancer and other re**al diseases is performed in Ghana exclusively at Mwin Tuba Hospital & Colo-Proctology Centre. The procedure is associated with rapid recovery and early discharge, with most patients returning home by the third postoperative day.
On 20/12/2025, a 76-year old man with low re**al cancer, 6cm from the a**l verge, underwent a successful laparoscopic Intersphincteric resection of the re**um, adding to the tally of earlier similar cases. He had a stage three re**al cancer with no distant metastasis. He underwent prior chemotherapy and concurrent radiotherapy.
Without ever disappointing, this remarkable surgical milestone was achieved by our locally trained laparoscopic surgical team. The team comprised Dr Theodore Wordui (Lead Laparoscopic Surgeon), Dr Philemon Kumassah (Consultant Surgeon and Post-Fellowship Trainee in Colore**al and Laparoscopic Surgery), Dr Isabella Dakubo (Trainee Surgeon), Dr Divine Kwami (Consultant Anaesthetist), and Mr Stafford Tackie (Anaesthesia Assistant).
The peri-operative team included Mr Emmanuel Tampah-Naah (Principal Peri-operative Nurse), Freda Brako (Assistant Theatre/Circulating Nurse), and John Tandoh (Operating Room Assistant), with Prof Dakubo focusing exclusively on the a**l component of the procedure.
Following this successful surgery, the patient has entered remission and will be placed on surveillance for five years, after which he will be managed like any other individual in the general population of his age.
Mwin Tuba Hospital continues to set the pace in modern surgical practice in Ghana through the introduction of laparoscopic surgery for all abdominal conditions and the training of younger surgeons in this specialized skill for national capacity building. This commitment has positioned the hospital as the first point of call for many patients seeking effective, efficient, and contemporary surgical care that meets global best practices.
If it can be done closed, why open?
For God and country.
Prof Jonathan CB Dakubo
