2-week-old conjoined twins separated successfully in 6-hour surgery

 2-week-old conjoined twins separated successfully in 6-hour surgery

 

Sagaya Fernando

Mumbai: 28 January 2021

 

A team of paediatric surgeons, neonatologist, paediatric anesthesiologists, plastic surgeons, radiologists, cardiac surgeons at Bai Jerbai Wadia Hospital for Children, Mumbai, India, successfully separated conjoined twins through a 6-hour complicated surgery on January 3. 

 

The twins, both girls born on December 21, were joined at the abdomen and shared a liver, lower chest bone and abdominal cavities.

 

The omphalopagus twins – joined in the abdomen by the belly-button – are rare with one in 50,000 births and low survival rates.

 

The twins’ mother was left devastated after an antenatal ultrasound scan performed suggested that the twins were joined at the abdomen. She then approached Bai Jerbai Wadia Hospital for Children.

 

 “The twins were Omphalopagus joined together from chest bone toumbilicus. Extensive counseling of parents about the complexity and rarity of the condition and knowledge preparation of the treating team started soon after they approached our hospital,” said Wadia Hospital CEO Dr Minnie Bodhanwala.

 

She added, “Every aspect of treatment was challenging starting from the safe delivery of children to successful separation. The mother was followed up closely till term and then the twins delivered by a planned cesarean-section in the presence of the whole team.”

 

The babies had a combined weight of 4.2 kilograms at birth, and were kept in the NICU after birth. The babies were clinically active and fused at the abdomen from the lower part of the sternum to the common umbilicus. The babies then underwent extensive investigations to understand the anatomy and complexity of separation surgery.

 

 “On CT scan imaging, the twins shared a liver, lower chest bone, and presumably intestines. They were nursed maintaining some distance to stretch the tissues so as to obtain adequate cover at the time of surgery. The decision of going into separation was a perplexing task. Delaying surgery till babies grow makes surgery easier for surgeons but difficult for parents to look after them,” said Dr Bodhanwala.

 

She underscored, “One baby was pink while the other was pale. CT scan also showed one major vessel going from one baby to another resulting in differential circulation. This is known in omphalopaguses sharing a common liver which ultimately leads to overloading one baby in turn cardiac failure. All the complexities, risks, and benefits of early versus late surgery were discussed with parents who opted for separation surgery which was carried out on the 14^th say of their birth.”

“They were having a common liver and were joined from the lower chest bone up to the umbilicus. Special technology of cutting liver using a harmonic scalpel and T seal was used which minimized blood loss to less than 10 ml. The entire procedure lasted for 6 hours and the babies needed post-operative ventilator support for 2 days. Gradually, the babies were started on feed three days after the successful operation. The babies are now active on full feeds with gradual weight gain, their wounds have healed well,” stated Dr Bodhanwala.

 

“After discharge, we have designed a multidisciplinary followup programme to monitor the growth, development, nutrition, liver function and immunization of the babies,” she added.

 

“Conjoined twins are seen in 1:50000 to 1:200000 of all live births and less than 300 successful surgical separations have been done in the past. Omphalopagus twins comprise 10% to 18% of all conjoined twins. This is the fourth successful separation of conjoined twins successfully performed at Wadia hospital, the last three being in the last 7 years,” informed Dr Bodhanwala.