Tuesday 12 December 2017

Surgical team prepares to separate conjoined twins

Ralph Riegel

Ralph Riegel

A TOP British surgical team is preparing to separate conjoined Irish twin boys born in December.

The surgery will take place later this year, once the two boys -- born six weeks ago to an Irish mother -- gain strength and weight.

Historic studies of conjoined or 'Siamese twins' show the boys -- who are not understood to share a single, major organ like the heart or liver -- now have an 80pc-plus chance of a successful operation and recovery.

The boys were born to a Cork mother in London's University College Hospital (UCH), where she had been transferred for specialist medical care.

The woman -- who does not wish to be identified -- travelled to London for the birth in mid-December in consultation with her doctors at Cork University Maternity Hospital (CUMH).

The couple have declined to comment on the nature of the twins' conjoining or when the separation operation is planned.

But the couple hailed the battling qualities of the twin boys and said they were delighted at the prospect of bringing them home.

The care of the twins is now shared between CUMH and Great Ormond Street Hospital for Children-NHS Trust (GOSH) in London, one of the world's leading paediatric hospitals.

The boys have been thriving since their birth and are now ready to be allowed home to regain their strength for the separation procedure later this year.

The boys are the first conjoined twins born to an Irish mother since 2005.

They are not believed to share any major organs -- and are understood to be joined at the torso.

In a statement, the couple said they are absolutely delighted with how things have progressed so far.

"We are very proud of our two little boys and we feel blessed by their arrival six weeks ago," the parents said.

"We needed time together first as a family and to see how the boys were doing. Presently, they are feeding well and (gradually) gaining weight.

"We are planning for the boys to come home soon and we are asking the media and the public to let us enjoy this special time with our two little fighters before their separation later this year," they added.

The couple said they were overwhelmed by the support and kindness shown to them by medical teams both in Ireland and the UK.

A spokesperson for CUMH said both boys are doing extremely well.

"Both boys are medically very well, taking their feeds and gaining weight. The neonatal team in Cork is working closely with the family and Great Ormond Street Hospital with the boys' treatment and clinical care."

Conjoined twins are extremely rare and only occur on average once in every 250,000 births.

The condition is caused by a single egg being fertilised and then splitting in two within the mother's womb.

However, the process of embryo separation is halted before it is totally complete, resulting in the development of a conjoined foetus.

While now referred to as conjoined twins, the condition is best known as 'Siamese twins'.

This was because the first and most high-profile case documented by modern science occurred in 1811 when twins, Eng and Chang, were born in Siam (now Thailand). They achieved worldwide fame because of their conjoining.

Ireland witnesses the birth of conjoined twins on average once every five years -- with the last twins being born at Holles Street Hospital in Dublin in 2005.

In their case, a surgical separation proved impossible.

It is estimated that about 70pc of conjoined twins born are likely to be female.

Tragically, about 40pc of all conjoined twins are stillborn.

While advances in medical care over the past half century have revolutionised the treatment of the rare condition, about one-third of conjoined twins still die within the first 36 hours of life.

Of those born alive, on average just one-in-three are deemed medically suitable for separation operations.

In most cases, separation procedures are deemed impossible when the twins share a major organ such as the heart or liver.

The majority of cases involve twins being joined at the torso -- either by their chest or stomachs.

Only a minority of cases involve twins being joined at the head.

Surgeons classify conjoining in three ways:

  • 73pc are conjoined at mid-torso (at the chest wall or upper abdomen).
  • 23pc are conjoined at lower torso (sharing hips, legs or genitalia).
  • 4pc are conjoined at upper torso (connected at the head).

Advances in medical science have meant that separation procedures are now increasingly successful though surgery remains high-risk.

The first surgical separation occurred in 1953, but success rates have soared since then with doctors now able to rely on micro-surgery and high-tech diagnostic equipment.

Ireland's most high-profile separation case came in 1997 when Aoife and Niamh McDonnell, from Castlebar, Co Mayo, underwent surgery.

The operation on the twins took place in a Manchester hospital almost three months after their birth in April 1997.

A second high-profile separation was less successful, when Eilish and Katie Holden from Co Kildare were operated on in 1998. Sadly, Katie died shortly after the surgery.

GOSH consultant paediatric surgeon, Dr Edward Kiely, said medical teams are already planning for a possible separation procedure on the boys later this year.

"If all goes according to plan the children will return to Great Ormond Street Hospital later in the year," he said.

"The surgical team here is the most experienced in Europe at assessing and, if necessary, separating conjoined twins," Dr Kiely added.

Sunday Independent

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