Bangalore, 21st December, 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.

Conjoinedtwins are a rare event, occurring once in 100,000 births. Their survival rateis very low, about half of them may die before birth and another 25% soonthereafter. Only 25% survive in infancy.  Conjoined twins arise from asingle embryo. Hence they are identical and of the same sex. However, unlikenormal twins, there is a failure of separation in fetal life and the pair of themis joined at some part of their bodies. Internal organs in this area of joiningare also shared between the two.  

In the caseof James and John they were omphalopagus twins. They were referred to NarayanaHealth for evaluation and separation. On arrival, the pediatric surgery team atNarayana Health thoroughly evaluated the children’s condition.  As thefamily had done an excellent job of caring, they were in good health. Besidesdetailed clinical examination by a multidisciplinary team, the team at NarayanaHealth also did detailed imaging studies. All aspects of their anatomy weredetailed, discussed and a well chart out plan was made for the separationoperation. Fortunately for the babies, barring liver, all other organs such asintestines and biliary tree were separate. The liver was carefully dividedalong anatomical planes and the twins were separated. The babies required useof a mesh to ensure closure of their abdomen and that was also donesuccessfully. Post operation, they have not only made a rapid and unremarkablerecovery but also are in a position to live independent lives. 

Elaboratingabout the challenges faced in the case, Dr. Ashley D’Cruz, Director& Senior Consultant Pediatric Surgeon & Urologist, said,“Separationof conjoined twins calls for a very detailed and complex intervention. Firstand foremost, the medications had to be calculated and distributed to bothbabies in a manner that both received optimal doses. Further, sedation andanesthesia had to be provided to both the babies. This is specificallychallenging in this case as they are lying on their sides and cannot be putflat on their backs. Also, due to potential for cross circulation, carefuladministration of drugs had to be ensured.” 

A dedicated,full time multidisciplinary team with the world-class infrastructure andexpertise ensured optimal care was given to these young infants both pre-andpost the operation. 

“The goalof surgery is to achieve a safe separation and to have two normal children withno morbidity and disability. The main factor influencing success of treatmentis the shared anatomy and organs. Successful separation is often very tough,but in James and John’s case, through careful planning and coordination betweenthe various teams-medical, nursing, administrative, international liaisonhelped in the successful separation of the babies. The operation wassuccessfully done by an interdisciplinary team consisting of six surgeons, sixanesthetists, four anesthetic technicians, six nurses amongst others.” Added Dr. Sanjay Rao, SeniorConsultant, HOD of Paediatric Surgery and Senior Consultant, Division of OrganTransplantation 

Thedepartment of pediatric surgery at NH Bangalore has had experience of treatingseveral pairs of conjoined twins. Till date the team has successfully treated 6such complex cases. The cases range from separating extra torso to separationof conjoined twins.

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