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Conjoined twins are identical twins whose bodies are
joined in utero. A rare phenomenon, the occurrence is estimated to range
from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher
incidence in Southwest Asia and Africa. Surgery to separate conjoined
twins may range from relatively simple to extremely complex, depending
on the point of attachment and the internal parts that are shared.
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Angelica and Angelina Sabuco
Angelica and Angelina Sabuco, twins who were born conjoined at the chest
and abdomen, are now separate little girls. The 2-year-olds were
separated Nov. 1 2011 in a 10-hour surgery at Lucile Packard Children's
Hospital. The operation was the culmination of several months of complex
planning involving specialists from nearly every part of the hospital.
The riskiest portion of the procedure, dividing the girls' fused livers,
went slowly but smoothly. Hemorrhage had been a concern because one
quarter of the body's blood supply passes through the liver each minute.
But thanks to the state-of-the-art equipment the team used to divide the
tissue and cauterize the girls' blood vessels, virtually no blood loss
occurred during that part of the procedure, said Hartman, clinical
professor of pediatric surgery at the School of Medicine.
The surgery was the second separation of conjoined twins performed at
Packard Children's. The first pair was successfully separated in 2007 by
a team that Hartman led. The Sabucos' operation was less complex because
they shared fewer organs.
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Hassan and Hussein Benhaffaf
They may have been separated by surgeons but, as this heartwarming
picture shows, they are determined to face the world together. Pictured
after the operation to part them, conjoined twins Hassan and Hussein
Benhaffaf lie hand-in-hand, just as they did in the womb. The
five-month-old boys returned home, seven weeks after they were separated
by surgeons at London's Great Ormond Street Hospital. Born last December
at London's University College Hospital, Hassan had his arm around his
brother.
The boys then returned to Ireland to build up their strength for April's
gruelling 14-hour operation at Great Ormond Street, during which, more
than 20 medics, including four surgeons and four anaesthetists, worked
in shifts to separate them. Although the boys each had their own heart,
the organs shared the same safety 'sac', making the op more complex.
Their liver, gut, bladder and pelvis also had to be separated. They have
one leg each and are likely to be fitted with prosthetic limbs in the
future.
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Maria Paz and Maria Jose Paredes Navarrete
Chilean doctors successfully separated conjoined twin girls after a
marathon 18-hour surgery. The 10-month-old twins Maria Paz and Maria
Jose are in stable condition even after losing a lot of blood and they
are resting in the intensive care unit at Luis Calvo Mackenna Hospital.
Parents Jessica Navarrete and Roberto Paredes kept an anxious vigil at
the hospital in Santiago as doctors separated the twins at the thorax,
stomach and pelvis. It was the seventh and most complex operation yet
for the twins. He added that the twins came out of the surgery in 'good
condition'.
Navarrete said she was waiting for 'a miracle from God' when the
high-risk operation began, which was widely followed in the South
American country on television and the Internet. The Chilean twins
presented a particularly difficult challenge because they were born
sharing many of the same internal organs and even urinary system. About
100 people participated in the procedure, including 25 surgeons and
anaesthesiologists.
According to the University of Maryland Medical Center, one out of every
200,000 live births worldwide results in conjoined twins. About 35 per
cent survive only one day, while the overall survival rate is from 5 to
25 percent.
UPDATE: One of the twins, Maria Jose Paredes Navarrete, passed away four
days after the surgery due to general organ failure.
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Rital and Ritaj Gaboura
In September 2011, twin girls born joined at the head have been
successfully separated by British doctors. Rital and Ritag Gaboura, who
are 11 months old, survived at odds of one-in-10 million. They had four
complex operations at London's Great Ormond Street Children's Hospital.
The sisters, who were born in Khartoum, Sudan, were brought to Britain
for the procedures by their parents Abdelmajeed Gaboura, 31, and, Enas,
27, who are both doctors. By the time they arrived, Ritag's heart was
already failing.
Rital and Ritag were born with one of the most serious forms of the
condition as they shared blood vessels, and there was significant blood
flow between their brains. Ritag supplied half her sister's brain with
blood and drained most of it back into her own body to re-oxygenate –
meaning her heart was doing most of the work for both of them. Any
significant drop in blood pressure during surgery could have caused
brain damage. While both girls are as alert as they were before the
operation, it could be years before their parents and doctors discover
if they have suffered any long-term problems.
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Trevor and Timothy Bainomugisha
The five-month-old Siamese twins of Kabale have been successfully
separated by a team of doctors. The twins, Trevor and Timothy
Bainomugisha, born conjoined on June 10, 2011, are now able to live
their lives as separate individuals. The twins, along with their
parents, Dennis Owomugisha and Rosette Tusiime, are from Kekubo, Kabale
Municipality in Western Uganda.
The operation was conducted by five specialized surgeons with the
support and supervision of a number of doctors and medical personnel.
Tim and Trevor were separated without having to perform organ
transplants. Owomugisha said that after the operation the twins had
started to play, yet they were put to sleep so that they would not feel
the pain and that the surgical wound would heal quickly. The twin
brothers' status is closely monitored by a doctor at the hospital.
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Yurelia and Fiorella Rocha-Arias
Maria Elizabeth Arias is glad to push two strollers and chase after her
two daughters when they run in two separate directions. These are just
some of the “twos” Maria dreamed about before she brought her
3-year-old, conjoined, twin daughters, Yurelia and Fiorella Rocha-Arias,
to Packard Children's to undergo high-risk separation surgery. Now,
after sailing through surgery and recovery, the Costa Rican girls have
returned home to share their miracle with family and friends. At the
same time, the largest team of doctors and caregivers ever to
collaborate on a single case at Packard Children's—and the first of its
kind for the hospital—reflects on how it went so well.
General pediatric surgeon Gary Hartman, MD, conducted the November 12
2007 symphony—a 23-member, multidisciplinary team inside the operating
room and countless others outside.
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Clarence and Carl Aguirre
Clarence and Carl Aguirre (born April 21, 2002) are former conjoined
twins born in Silay City, Philippines. They were conjoined at the top of
the head (vertical craniopagus). In 2003 they were brought to the United
States by their mother Arlene in the hopes of having them surgically
separated. A revolutionary new process was used in separating the twin
boys. Because "marathon" surgical operations have historically led to a
high rate of mortality and morbidity, Clarence and Carl's doctors chose
to separate them in several smaller operations, allowing the twins to
recuperate after each surgery.
In October 2003, tissue expanders (pouches filled with saline) were
implanted under the boys' scalps. This is common practice in separating
conjoined twins, as it creates more skin that can be used to cover the
twins' wounds after separation. Over the next ten months, the brothers
underwent several more surgeries to tease apart their joined skulls and
brains. On August 4, 2004, the final surgery was completed. All of these
surgeries were performed at Montefiore Medical Center in Bronx, New York
by a team led by Dr. James T. Goodrich, a pediatric neurosurgeon and Dr.
David A. Staffenberg, a plastic surgeon. They received most of their
post-operative rehabilitation at Blythedale Children's Hospital in
Valhalla, New York (Westchester County).
The Aguirre brothers and their mother now live in a donated house in
Scarsdale, New York. The twins continue to attend physical therapy at
Blythedale. As of July 2008, the twins were both in school with children
their own age.
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Lakshmi Tatma
Lakshmi Tatama is an Indian girl born in 2005 in a village in
Araria district, Bihar, having "4 arms and 4 legs." She was actually one
of a pair of ischiopagus conjoined twins where one twin was headless due
to its head atrophying and chest underdeveloping in the womb. The result
looked like one child with four arms and four legs. Some of the local
villagers had hailed her as the reincarnation of Lakshmi, the
multi-limbed Hindu goddess. In November 2007 she successfully underwent
surgery to remove the parasitic twin. Now fully recovered from the
27-hour operation to save her, Lakshmi is almost unrecognizable from her
former self.
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