Although the extent of the unmet need for surgeries is well-known, little is known about the surgery performed in district hospitals in sub-Saharan Africa. We review five years of utilization of theatre services at the Kintampo Hospital in rural Ghana. The source of data was the theatre logbook and other hospital records for the period 2005-2009. During this time, 1391 surgeries were performed in the theatre. This approximates a rate of 250/100,000 population. Fifty-two percent were performed in patients aged 18-35 years. The most frequently performed surgeries were: caesarean sections (46%); hernia repair (41%); and other laparotomies (10%). The major indications were cephalopelvic disproportion, right inguinal hernia and typhoid perforation, respectively. Typhoid perforation was the main indication for surgery in children aged less than 10 years. The potential for an expansion of the scope of services should be explored in order to improve access to essential surgery for this population.