Twin girls sharing a liver separated in rare surgery

Mangalore Today News Network

Kashmir, Nov 27, 2014: Two-month-old conjoined twin girls from Kashmir fused at the abdomen and sharing a liver were successfully separated in a Gurgaon hospital on November 15.

 

The twins, Saboora and Safoora, were conjoined in a type of fusion termed as omphalopagus, that required their joint abdominal wall to be opened, the common liver divided between the two and the abdominal wall reconstructed.

Dr A S Soin, chairman of the liver institute at Medanta Medicity, where the girls were separated, said, “There is no described anatomy of a liver that is shared between two humans and no standard technique to split it. The separation of the liver had a high risk of bleeding and the danger of landing up with an inadequately functioning liver in one or even both babies.”

Explaining the decision to separate the babies, Dr Soin said, “We took a long time before deciding on the surgeries. It was a dilemma whether we were right in disturbing them when the odds were against their survival.”

In 2012, 11-month-old twins fused in a similar condition with a common liver but different blood supplies had been successfully separated in a charitable hospital in Betul, Madhya Pradesh. One of the babies, however, had died 15 days after the procedure.

In this case, doctors said both babies have a good chance of survival because other organs such as heart and the intestines were separate. “The intestines of each were floating in the other’s body but the size of the liver was quite big so we could successfully separate them in a 60:40 ratio,” Dr Neelam Mohan, director of paediatric gastroenterology at the hospital, said.

The father of the girls said having his daughters live separate lives was a blessing. “Daily activities like feeding them, changing their clothes and putting them to bed was a challenge. When we got them here, everybody discouraged us from going ahead with the surgery.

We were giving up hope. Today it is a blessing to see the two happy and healthy,” the father, who did not wish to be named, told Newsline.

The condition is rare and occurs once in 1,00,000 births, with 3 out of 4 cases being girls. “Preparing the twins for surgery was a unique challenge too, needing improvisation even for simple procedures like blood sampling, X rays and scans,” Dr Mohan explained.

Administering anaesthesia was difficult as both babies had to be kept on the same operating table, but connected to two different anaesthesia machines, two ventilators, and managed by two anaesthesia teams. “The medicines administered to one would have an unpredictable effect on the other twin as their circulations were connected via the liver, so we had to take special care,” Dr Vijay Vohra, chief of anaesthesia, said.

Once separated, one baby was shifted to another operating room so that plastic surgeons could work on their abdomens separately,to reconstruct the deficient abdominal wall. Doctors said the liver function in both babies was normal, as periodical tests indicated.

 

Courtesy: indianexpress