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Team of Wadia hospital doctors with Dr Minnie Bodhanwala

Wadia Mumbai: Conjoined twins separated on 14th day of birth

 DTMT NETWORK
Doctors at Mumbai’s Bai Jerbai Wadia Hospital for Children, Mumbai, have successfully separated conjoined 14-days-old twins through a 6-hour complicated surgery on January 3, 2021.

The twins, who are baby girls, before separation, had a shared liver, lower chest bone and abdominal cavities. The hospital has said that twins are now fine and doing well.

The doctors used special technology of cutting the liver using a harmonic scalpel. T seal was used which minimized blood loss of less than 10 ml.

The complex surgery involved a team of paediatric surgeons, neonatologist, paediatric anesthesiologists, plastic surgeons, radiologists and cardiac surgeons.

According to the hospital, the twins were Omphalopagus joined together from chest bone to umbilicus.

Extensive counseling of parents about the complexity and rarity of the condition and knowledge preparation of the treating team started soon after they met the doctors of the hospital. Every aspect of treatment was challenging, starting from the safe delivery of children to successful separation.

The hospital has informed that the mother was followed up closely till term and then the twins were delivered by a planned cesarean-section in the presence of the whole team. The babies had a combined weight of 4.2kg at birth.

They were kept in the NICU after birth. They 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.

CT scan imaging findings revealed that 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.

As per the hospital, 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, and, 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 January 3, 2021. The babies were having a common liver and were joined from the lower chest bone up to the umbilicus.

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 Minnie Bodhanwala, CEO, Bai Jerbai Wadia Hospital for Children, said: “Conjoined twins are seen in 1:50000 to 1:200000 of all live births and less than 300 successful surgical separations have been 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 conjoints is about 50%. The exhaustive preoperative assessment, planning, and encouragement 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,” added Dr Bodhanwala.


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