Separation of Conjoined Twins : Children's Hospital Experiences
Nine conjoined (Siamese) twins were separated at the Children's Hospital, Bangkok, Thailand during the period between 1956 and 1995. Six cases were Omphalopagus type of conjoined twins, and the other three were Thoraco-omphalopagus type.
Thirteen children survived but five infants expired. Two infants died during the surgical attempt to separate. The other three infants expired after successful separation (thoraco-omphalopagus conjoined twins) due to severe cardiac anomalies.
As a result of our own experiences and a review of the literatures, delaying separation till late infancy of these conjoined twins were preferred. In 1989 more advanced investigations were introduced in addition to the routine preoperative studied. The fused visceral organs and the cardiovascular system were evaluated by computerized tomography or 3-dimensional computerized scan and other appropriate hemodynamic measures. These advanced techniques demonstrate the cardiovascular system more accurately which would allow more careful planning of a more complex separation of the twins. The success of the operation in our series depends on the closed co-operation between pediatricians, nurses, radiologists, the anesthesiologists and the surgeons. Multidisciplinary approach with rehearsal of the events are also very essential.
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