Hopkins Surgeons Successfully Separate Nigerian Conjoined Twin Girls

Pediatric surgeons Paul Colombani, M.D., director of pediatric surgery at the Children’s Center, and Henry Lau, M.D., led a 17-member medical team in the separation, which took place on September 11, 2003. During the procedure, surgeons divided the fused liver into two separate organs, one for each twin. The liver is the only organ in the body with the ability to regenerate itself, making separation possible.

“The surgery went very smoothly, with no problems at all, and the twins are doing very well,” said Colombani, who separated conjoined twins in 1993. “The next step for the twins is normal life. They will grow and develop into healthy little girls.”

The surgical team convened at 8:00 a.m. to begin administering anesthesia to the twins. Surgery began at 11:00 a.m. with separation of the twins’ chest bone, abdominal wall and the liver, which surgeons split between the babies.

Following the surgical separation, which lasted one hour, the medical team broke into two groups, one for each twin, to close the incision in the “bridge”, or the conjoined area. Color-coding was used to easily identify the team assignments for each twin. The “yellow team” remained in the original operating room with Favour, and the “red team” moved to a nearby room with Faithful.

Because the abdominal wall in young babies is flexible and can be stretched, surgeons were able to close each girl’s abdominal cavity using her own abdominal muscles and skin flaps, and did not need to use skin grafts or prostheses. One hour later, at 1:00 p.m., surgery was complete and both twins were in recovery.

Colombani said the success of the surgery is partly due to the fact that the girls did not share any major organs, such as the heart, which can happen in cases of thoraco-omphalopagus twins, or twins connected at the chest and abdomen.

“I consider this surgery to have been one of the most simple of all conjoined twin separations because the liver can be divided easily and it regenerates itself,” he added.

Colombani predicted the twins, who were born in Nigeria on July 17, will likely be discharged from the hospital this week. However, they and their parents will remain in the Baltimore area for at least a month for post-operative monitoring before returning to Nigeria.

Faithful and Favour arrived at the Children’s Center on September 8 for pre-operative testing, including CT scans and anesthesia consultations. They were accompanied to the Children’s Center by a four-member medical team from Lagos Island Maternity Hospital where the babies were born. The Nigerian team is traveling with the Sobowale-Davies family, and observed Thursday’s surgery.

Conjoined twins occur once in every 70,000 to 100,000 live births. The most common type of conjoining is thoracopagus, or twins conjoined at the chest, which happens in approximately 34 percent of all cases.

Johns Hopkins Children’s Center surgeons have separated six sets of conjoined twins since 1982. Most recently, in 2003, Benjamin Carson, M.D., traveled to Singapore and co-led an international medical team in the historic separation of 29-year-old conjoined twins Laleh and Ladan Bijani, who were joined at the head. Although the twins were surgically separated, both died during surgery due to blood loss.

Conjoined Twins Fact Sheet: http://www.hopkinschildrens.org/pages/news/twins_factsheet_9_03.html

Surgical Team: http://www.hopkinschildrens.org/pages/news/surgical_team.html

Surgical Team Bios: http://www.hopkinschildrens.org/pages/news/surgical_team_bios.html