Conjoined Twins Surgery In India

After much brainstorming, the team decided to plan for separation in three stages. In the first stage, tissue expanders will be placed to get adequate skin for covering the raw areas after separation. In the second stage, actual separation of the spinal cords, intestine and genito-urinary tract would be carried out along with reconstruction. In same stage, a temporary opening (colostomy) for passage of stool would be made on the abdominal wall. In the third stage, colostomy would be closed after 6 weeks. The team met regularly during the next two months to put the surgical plan in place. Flowcharts detailing the moves of each and every person involved in the surgery were meticulously prepared and refined. Every surgical step was defined and rehearsed over and over again till it reached precision. The girls were color coded (one pink and the other blue) so that there would be no error at all. This color code was extended to all catheters, wires, tubes and leads that would be connected to the girls during surgery. The team decided to use an advanced technique of neuro-monitoring to avoid any damage to the nerve roots of both spinal cords. The anesthesiologist’s job was made all the more challenging by the fact that whatever drug was given to one twin, the other would receive it inadvertently through a large sharing vein, and dosages were calculated and monitored accordingly. Surgical steps were practiced using dummies procured for the purpose. Reconstruction of high definition images showed that the twins had a shared blood circulation, thereby extending a clue to the anesthesiologists to plan for managing the risk of passing of drugs from one child to another during surgery. Each twin was assigned a separate team of doctors representing each specialty, some of whom were not participate in the surgery but would be on standby if anything went wrong.

May 25, step 1

August 12, step 2 (After separation in ICU)