Mumbai: 14-day old conjoined twins separated in 6-hour operation

In a rare surgery, 14-day-old conjoined twins were successfully separated from the abdomen after doctors at Bai Jerbai Wadia Hospital performed a six-hour long complicated surgery to give the infants a new lease of life. Both girls, who were joined at the abdomen and shared a liver, lower chest bone and abdominal cavities are now living as two healthy kids. Doctors said after discharge, they have designed a multidisciplinary follow-up programme to monitor the growth, development, nutrition, liver function and immunization of the babies.

Doctors said that the young couple was delighted with their pregnancy. But, the lady felt devastated after an antenatal ultrasound scan performed suggested that they have twins who are joined at the abdomen probably conjoined. Moreover, extensive counseling of parents about the complexity and rarity of the condition and knowledge was done soon after they approached Bai Jerbai Wadia Hospital.

“The twins were Omphalopagus joined together from chest bone to umbilicus. 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 kg at birth, 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,” a doctor at Bai Jerbai Wadia Hospital said.

Doctor further added, 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.

“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 omphalopagus 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 Day 14. The surgery was performed by the team of paediatric surgeons anesthesiologists in the presence of neonatologists and cardiovascular thoracic surgeons in the operation theatre,” added doctor.

“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 postoperative ventilator support for 2 days. Gradually, the babies were started on feeds since Post-operation, day 3. The babies are now active on full feeds with gradual weight gain, their wounds have healed well,” said doctor.

Dr Minnie Bodhanwala, CEO, Bai Jerbai Wadia hospital, said conjoined twins are seen in 1:50000 to 1:200000 of all live births and less than 300 successful surgical separations are done in the past. Omphalopagus twins comprise 10 per cent to 18 per cent 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 seven years. The success rate of conjoint is about 50 per cent,” she said.

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