Bangalore, December 20, 2017: Six month old James and John are back to their playful self after the corrective surgery at Narayana Health City. Hailing from Nigeria James and John were conjoined twins. The babies were omphalopagus twins, that is they were joined at the upper part of their abdomen. The doctors at Narayana Health City have successfully separated them giving them a new lease of life.
Conjoined twins are a rare event, occurring once in 100,000 births. Their survival rate is very low, about half of them may die before birth and another 25% soon thereafter. Only 25% survive in infancy. Conjoined twins arise from a single embryo. Hence they are identical and of the same sex. However, unlike normal twins, there is a failure of separation in fetal life and the pair of them is joined at some part of their bodies. Internal organs in this area of joining are also shared between the two.
In the case of James and John they were omphalopagus twins. They were referred to Narayana Health for evaluation and separation. On arrival, the pediatric surgery team at Narayana Health thoroughly evaluated the children’s condition. As the family had done an excellent job of caring, they were in good health. Besides detailed clinical examination by a multidisciplinary team, the team at Narayana Health also did detailed imaging studies. All aspects of their anatomy were detailed, discussed and a well chart out plan was made for the separation operation. Fortunately for the babies, barring liver, all other organs such as intestines and biliary tree were separate. The liver was carefully divided along anatomical planes and the twins were separated. The babies required use of a mesh to ensure closure of their abdomen and that was also done successfully. Post operation, they have not only made a rapid and unremarkable recovery but also are in a position to live independent lives.
Elaborating about the challenges faced in the case, Dr. Ashley D’Cruz, Director & Senior Consultant Pediatric Surgeon & Urologist, said, “Separation of conjoined twins calls for a very detailed and complex intervention. First and foremost, the medications had to be calculated and distributed to both babies in a manner that both received optimal doses. Further, sedation and anesthesia had to be provided to both the babies. This is specifically challenging in this case as they are lying on their sides and cannot be put flat on their backs. Also, due to potential for cross circulation, careful administration of drugs had to be ensured.”
A dedicated, full time multidisciplinary team with the world-class infrastructure and expertise ensured optimal care was given to these young infants both pre-and post the operation.
“The goal of surgery is to achieve a safe separation and to have two normal children with no morbidity and disability. The main factor influencing success of treatment is the shared anatomy and organs. Successful separation is often very tough, but in James and John’s case, through careful planning and coordination between the various teams-medical, nursing, administrative, international liaison helped in the successful separation of the babies. The operation was successfully done by an interdisciplinary team consisting of six surgeons, six anesthetists, four anesthetic technicians, six nurses amongst others.” Added Dr. Sanjay Rao, Senior Consultant, HOD of Paediatric Surgery and Senior Consultant, Division of Organ Transplantation
The department of pediatric surgery at NH Bangalore has had experience of treating several pairs of conjoined twins. Till date the team has successfully treated 6 such complex cases. The cases range from separating extra torso to separation of conjoined twins.