No miracle, a medical problem

I have done two successful separations of conjoined twins, the second one as recently as July 11, 1998. There have been a total of 18 suc...

I have done two successful separations of conjoined twins, the second one as recently as July 11, 1998. There have been a total of 18 such separations all over the world so far. Conjoined twins is a rare condition, and its incidence is one in 60,000 live births in India and one in 1,00,000 live births in the world.

Twins are born when the female ovum is simultaneously fertilised by two male sperms. Generally, the ovum splits completely into two, and the two foetuses grow separately. But when the split is not complete and the body remains joined at some place, they become conjoined twins and have to be separated after birth.

Such twins are classified depending on the part of the body where they are joined. Craniopagus twins are joined at the skull, Thoracopagus twins are joined at the chest, Omphalopagus at the abdomen and Piopagus at the legs. This condition can be diagnosed early with the help of antenatal sonography, and parents are advised to go in for an abortion. But if the pregnancy is more thanfive months old, the only option is to wait for the delivery, and such cases get shifted to any paedriatic surgical centre.

During the delivery, the paedriatic surgeon stays present inside the labour ward, so that chances of survival of the conjoined twins are better. After the delivery, the twins are investigated and after understanding the anomalies in their condition, they are taken up for operation. If the twins are not joined at the heart or the liver, the operation can be done later and the case can be studied further.

But if there is a venous connection between the two, one baby starts bleeding into the other while waiting for the operation, which can lead to the death of both. In fact, this had happened during the separation of the Siamese twins last year, but it was noticed and corrected in time. While the actual operation to separate the twins takes four to six hours, it takes one hour to administer the twins anaesthesia.

Post-operative care is of equal importance, and the separated twins haveto be kept in isolation so that they do not catch any infection. Ventilatory support is required for them and the intake-output of fluids has to be maintained during this period. The first 10 days are crucial and if the separated twins are fine during this period, they are discharged after another week at the hospital.

For a doctor, it is important to try and separate the conjoined twins as well as try to save both the babies. I read about the recent birth of such twins at Nalasopara, and if they are brought to me, I can definitely convince the parents to go in for an operation to separate them. The parents are under the impression that the twins are some incarnation of God and therefore do not want them separated. It is difficult to say how long these conjoined twins will survive, and it all depends on the anomalies in their condition. Like, if the two babies have a single heart, chances of survival are less.

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But such things happen because of myths and misconceptions of the people, and everybody shouldrealise that conjoined twins is just a medical problem and should be treated as such. We had a similar case some years back, but the twins died of infection before they could be separated.

Conversely, in the first reported case of Siamese twins, they remained unseparated and lived to the age of 62. And the amazing thing is that they both got married and had six and seven children respectively. In fact, in a major development, conjoined twins who were joined at the skull were separated in the USA recently.

Even in the Nalasopara case, if the parents cannot afford the operation, there are hospitals which are willing to do it free. The separation that was done last year at Hinduja Hospital, for instance, was free of cost.

Dr Ila V Meisheri is a paedriatic surgeon