Twins separated at last

By Dave Opiyo

Nairobi, February 2, 2023:

A pair of conjoined twins were successfully separated during a 15-hour complex surgery by a team of multidisciplinary medical experts at Kenya’s premier referral hospital.

The male infants, born four months ago in Bungoma County and who were joined at the chest and abdomen at birth, began a new life apart on Sunday after the delicate surgery at Kenyatta National Hospital (KNH).

The operation which began on Saturday night at a10pm ended on Sunday at midday.

It was conducted by a dedicated team of at least 38 medical experts from KNH and the University of Nairobi (UoN) led by peadiatric surgeon Dr. Joel Lessan. The team had 24 surgeons; Plastic and Reconstructive (5), Peadiatric Surgeons (14), Anaesthetists, and Cardiothoracic (1) as well as six nursing officers.

The twins have been under observation since September last year. Doctors described their condition as ‘Thoracoabdominocophagus’, a situation where twins are joined face to face at the chest and abdomen.

Conjoined twins are the result of embryo cells that have not completely separated. Embryo cells develop when the egg (ovum) is fertilized by sperm. They multiply and differentiate to form different body organs and tissues. An alternative theory is that two separate embryos fuse in the early development of twins.

The exact cause of conjoined twins is unknown but it’s thought that genetic factors interacting with environmental ones may contribute. Another possibility is the medicines taken by the mother during pregnancy.

This type of conjoined twins often share a heart and may also share one liver and the upper intestine. This is one of the most common sites of conjoined twins globally.

In this case, however, the twins shared a liver and had two hearts in one cavity. Both hearts were abnormal. They similarly shared chest bones and muscles. In such cases, patients require close monitoring and treatment before a decision of their separation is duly agreed upon.

According to Dr. Lessan, the decision to operate on them came on Saturday night as an emergency after one of them suffered cardiac arrest calling for a swift yet calculated move on how to save their lives.

He said both children had multiple holes in their hearts, with one of them having an abnormal blood vessel originating from the heart.

This, he said, was compounded by a life-threatening infection at two months that was diagnosed and treated early enough.

Even though the target time for safe separation was to be at six months, one of the twins, he said, developed high pressure in the lungs, exposing them to even greater danger including imminent heart failure.

“This informed our team, even at four months, to start plans for separation. The challenge at this level was how to cover the defects left behind on their line of separation,” he said.

“However, last week on Thursday, we successfully developed flaps to cover the separation lines. We were to wait for another eight weeks before attempting complete separation. Unfortunately, two days after raising the flaps, one of the twins suffered a heart attack.

He was, however, successfully resuscitated.”

‘We made an emergency decision to separate the twins because subsequent cardiac arrest would put the lives of the other twin in danger, hence. We mobilized the team, equipment, and medication culminating in the successful surgery on Sunday,” he said.

Both infants are now under close monitoring and treatment at KNH’s ICU and are progressing well.

KNH’s Director of Surgical Service Dr. Kennedy Ondede attributed the success of the operation to surgical dexterity, teamwork, and dedication by the multi-disciplinary team.

“Proper planning, expertise, and careful preparation of the various sub-specialties is a critical part of this kind of surgery,” said Dr. Ondede.

KNH Chief Executive Officer Dr. Evanson Kamuri hailed the KNH team for yet another milestone. “This is a landmark. On this historic day, we have achieved yet another achievement in fulfilling our mandate as a top premier referral hospital,” he said.

“It was just amazing to see one set of conjoined twins turn into two separate children. We are dedicated to ensuring that their follow-up care nurtures them into happy and healthy children.

The KNH team seized the moment against all odds. We celebrate their dedication to achieve this incredible milestone today,” Dr. Kamuri concluded