The repair procedure was achieved with minimal access
A few weeks ago, the first abdominal aortic aneurysm repair was carried out in the Korle Bu Teaching Hospital. It was done with the patient completely awake.
The patient did not need to go to the intensive care unit. The patient went home in 4 days. With a diagnosis that was deadly. He escaped a surgery that had a 50% mortality and is now back home living a normal life. Problem solved.
The problem
An abdominal aorta aneurysm is a dilatation of the largest blood vessel in the body, more than 50% of its normal size. This vessel distributes blood/nutrients to the whole body. It occupies pride of place in front of the vertebral bodies of the spine. When it enlarges, it can cause back pain, abdominal pain, and when it grows large enough, may be felt as a pulsatile abdominal mass.
Not solving the problem, will lead to complications. The most feared is a rupture. The aorta is such a large vessel, that if its wall breaches, blood is lost rapidly. The body loses 5L in a minute. This is unsurvivable in most people, and only 15% of patients will reach the hospital. And of these, only 5% will make it unto the operating table. Of the 5%, half will die.
What could have caused this problem? What could have led to such a scourge, with this high mortality rate? The male sex, smoking, age above 65years, the Caucasian race, hypertension are some factors associated abdominal aorta aneurysm.
The treatment
If the enlargement is less than 50%, or less than 5cm, or the patient has no symptoms, medical treatment is all that is needed.
If it is more than 50% enlarged, or the annual rate of enlargement is 1cm/year or the patient has symptoms, it should be treated surgically. This could be done open, or endovascularly (a minimally invasive approach or “pinhole surgery”).
These two surgical modes of treatment are dependent on significant skill, finesse and dexterity, and have differing outcomes. In this patient, for the first time in Ghana, this problem was solved through the minimally invasive approach.
This ensured there was no need for intubation, no need for general anaesthesia with its known complications, there was no need for blood transfusion and the hospital stay was significantly shortened with an overall procedure mortality rate of 3%. The open treatment has a mortality of 10%, with high morbidity which may include anything from bowel ischaemia, acute renal failure, erectile dysfunction, to cardiac failure and pneumonia.
The Client
This 79-year-old man had been a hypertension patient for the previous 10 years and was well controlled on medications. He had been having vague abdominal pain for some time. After many visits, to different hospitals, he finally had a CT abdomen, and there it was. Waiting to blow-out.
By local anaesthesia the repair procedure was achieved with minimal access. He had only two 4cm incisions in the groin. There was no blood transfusion, he ate a full diet the evening of the surgery and was up on his feet from the next morning.
He was discharged home after just 4 days after an operation which otherwise would have been done under general anaesthesia with tubes emanating from every possible orifice of his body and a long surgical incision averagely 15cm from the xiphisternum to the symphysis pubis (overlook my inability to say this a more simplified way).
He would have had to be transfused several units of blood with its attendant risks. He would have had to be nursed in ICU after the operation for a minimum of 10-14 days during which he would not have been able to drink or eat. All these notwithstanding, the risk of dying from this operation stood at 10% and the average length of hospital stay for those who survive it is estimated at 21 days.
Patient’s commendation
After the success surgery, the patient had this to say: “I was taking to the cardio theatre of the Korle Bu Teaching Hospital at 7am on the 18th October 2019. After committing myself to God, the Endovascular Repair (Evar) operation began. It was amazing viewing all the operation on a giant monitor and in the course of the (4) four hours operation I was allowed to speak to my wife on phone and even invited her into the theater. I wish to thank the team of Doctors and nurses led by Dr. Lily Pincho Wu for a successful surgery. I also wish to thank the medical staff on the 6th floor of the surgical ward who took very good care of me. God richly bless you.”
