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Conjoined Twins Separated in 6-hour Surgery

Wadia Hospital doctors save the one-in-thousands twins

The twins had 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, Dr Pradnya Bendre of Wadia Hospital said.

MUMBAI, Jan 27 (The CONNECT) – A team of doctors separated conjoined twins through a six-hour complicated surgery at Wadia Hospital for children, Parel, Mumbai.

The baby girls who were joined at the abdomen and shared liver, lower chest bone and abdominal cavities are now living as two healthy kids after treatment by a team of pediatric surgeons, neonatologist, pediatric anesthesiologists, plastic surgeons, radiologists, and cardiac surgeons.

The hospital didn’t charge a rupee for the complicated surgery, an elated mother Neha (name changed) said.

The young couple were 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. However, the couple approached  Wadia Hospital in brave determination to bring these two lives to the world overcoming all the problems with a lot of hope.

Dr Pradnya Bendre, Professor & Head of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, said “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 treating team started soon after they approached the Wadia Hospital. 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 whole team. The babies had a combined weight of 4.2kg 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.

Dr Bendre said “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.” 

“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 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 of life on 3/1/2021. The surgery was performed by the team of paediatric surgeons anesthesiologis in the presence of  neonatologists and cardiovascular thoracic surgeons in the operation theatre, Dr Bendre said”

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 feeds since Post-operation, day 3. The babies are now active on full feeds with gradual weight gain, their wounds have healed well.

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

CEO Dr Minnie Bodhanwala 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% 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.  The success rate of conjoint is about 50 %. The exhaustive preoperative assessment, planning, and encouraging as well as financial support from the management lead to a 100% success rate. At 2 weeks, the twins underwent this challenging surgery and are ready to go home.”

“We were excited on my pregnancy, but, were petrified when informed that the twins were conjoined. Doctors at Wadia Hospital explained every minute detail about the rare surgery and ensured that the twins can lead a normal life after separation. The surgery was done seamlessly, and the hospital didn’t charge a single rupee for it. After separation, we haven’t faced any problems and are taking care of them like normal kids. We are elated that the kids have got a fresh lease of life this New Year,” said Neha.

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