Rarest of the rare surgery by Medanta

Conjoined Twin Girls with Single Shared Liver Separated Successfully

New Delhi, November 26: They might be ‘one’ in 5 crores. And Medanta Medicity might turn out to be the first hospital in the world to separate them in a rare feat of surgery! The story is of two month old Kashmiri twin girls who were joined at the abdomen and shared a common liver.

After successful separation surgery of this Siamese twin by team of 40 doctors for close to six hours at a stretch, Medanta mandarins also browsed internet to find a parallel in world literature but did not find one. Dr. A.S. Soin, Medanta Liver Institute Chairman and Chief Liver Surgeon and Dr. Neelam Mohan, Director of Pediatric Gastroenterology, Hepatology and Liver transplant said, “despite our best efforts, we could not find other such separation surgery. On the basis of what we could dig out from internet, the surgery can of course be dubbed a global feat but it is certainly the first such separation surgery in India.” They also created history in the sense that these Siamese twin turned out to be the world youngest recorded case.

Dr. Naresh Trehan, Chairman and Managing Director, Medanta, through a video conferencing, said, ‘there is no doubt Medanta team of doctors has pulled off a surgical miracle of sorts.’

Named ‘Saboora’ and ‘Safoora’, these girls were cynosure of all eyes today during media briefing. Father Hamid Hussain and Mother Israt have been blessed with this twin after the birth of a son. Doctors also gifted these girls separate belly buttons each. Both of them are in fine fettle and will have a full liver each in about three months time. Dr. Neelam Mohan acted like a doting mother and Dr. Soin, nicknamed as Uncle Liver, was bemused watching them being toast of the crowd.

Dr. A.S. Soin explained the complexity of the surgery in detail and said, ‘This was one of the most challenging surgeries of my career as a liver surgeon for two reasons. One was the fear of unknown- there is no described anatomy of liver that is shared between two humans and no standard technique to split it. Second, there was a great risk of bleeding and other dangers. There was no scope of even a shade of error.’

Conjoined twins are rare and occur once in 100,000 births, with 3 out of four cases being girls. Dr. Neelam Mohan said, ‘Preparing the twins for surgery was a unique challenge too as their being together always, they necessitated improvisation even for simple procedures like blood sampling, X-rays and scans. She said, ‘The chances that two twin girls sharing a common liver would be successfully separated were one in about 50 million. After the separation was done, the ICU management was difficult as their bodies took time to adjust to the sudden cessation of the shared circulation and metabolism.’

Dr Vijay Vohra, Chief of Anesthesia explained that anesthesia in this case was complicated as both had to be kept on the same operating table, but connected to two different anesthesia machines, two ventilators, and managed by two anesthesia teams. The medicines administered to one would have an unpredictable effect on the other twin as their circulations were connected via the liver.

Midway through surgery, once the twins were separated; one baby was shifted to another operating room so that plastic surgeons could work on their abdomen separately, to reconstruct the deficient abdominal wall. Dr R Khazanchi led the plastic surgery team that reconstructed the abdomen in both to give them a cosmetically acceptable scar, with new belly buttons .