Separation of Conjoined Twins : Children's Hospital Experiences

Authors

  • Anant Suwatanaviroj Department of Surgery, Children’s Hospital, Bangkok, Thailand
  • Sem Pring-Puang-Geo Department of Surgery, Children’s Hospital, Bangkok, Thailand
  • Sukawat Watanatittan Department of Surgery, Children’s Hospital, Bangkok, Thailand
  • Sriwongse Havanonda Department of Surgery, Children’s Hospital, Bangkok, Thailand

Abstract

                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.

References

1. Pring-Paung-Geo S. The six siamese twins. J Intnat Coll Surg Thai 1963;6:77-90.

2. Votteler TP. Conjoined twins. In: Welch KJ, Randolph JG, Ravitch MM, O'Neill JA Jr, Rowe (eds). Pediatric Surgery 4th ed. vol. 2 Chicago: Year Book Medical Publishers, 1986:771-9.

3. Potter EL. Pathology of the fetus and the newborn. Chicago: Year Book Medical Publishers, 1957:184-98.

4. Bankole MA, Oduntan SA, Ohrwansanmi JO, Itayemi SO, Khwaja S. The conjoined twins of Warri, Nigeria report of an ischiopagus tetrapus with a review of the literature. Arch Surg 1972; 104:294-301.

5. Poradowska W, Joworska M, Reszke S, Lodzinski K. Conjoined twins and twins parasite, Clinical analysis of three examples. J Pediatr Surg 1969; 4:688-93.

6. Benirshke K, Temple WW, Bloor CM. Conjoined twins: nosology and congenital malformation. Birth Defects 1978; 14:179-92.

7. Margouleff D, Harper RG, Kenigsberg K, Horn D, Cia CJ. Sequential scintiangiography of the hepatosplenic system of xiphopagus conjoined twins. J Nucl Med 1980; 21:246-7.

8. Synhorst D, Matlak M, Roan Y, Johnson D, Dyrne J, McGough E. Separation of conjoined thoracopagous twins joined at the right atria. Am J Cardiol 1979;43:662-5.

9. Schmidt W, Heberling D, Kubli F. Antepartum ultrasonographic diagnosis of conjoined twins in early pregnancy. Am J Obstet Gynecol 1981;139:961-3

10. Boles ET Jr, Vassy LE. Thoraco-omphalopagus conjoined twins: successful surgical separation Surgery 1979; 86:485-92.

11. Kiesewetter WB. Surgery on conjoined (Siamese) twins. Surgery 1966;59:860-71.

12. de Vries PA. Separation of the San Francisco Twins. Birth Defects 1967:3:75-9.

13. Gans SL, Morgenstern L, Gettelman E, Zukow AH, Cooperman H. Separation of conjoined twins in the newborn period. J Pediatr Surg 1968; 3:565-74.

14. Wooley MM, Joergenson EJ. Xiphopagus conjoined twins preoperative evaluation and surgical management. Am J Surg 1964;108:277-84.

15. Miller D, Colombani P, Buck JR, Dudgeon DL, Haller JA Jr. New techniques in the diagnosis and operative management of Siamese twins. J Pediatr Surg 1983; 18:373-6.

16. Messmer B, Hornchen H, Kosters C. Surgical separation of conjoined (Siamese) xiphophagus twins. Surgery 1981; 89:622-5.

17. Grossman HJ, Sugar O, Greeley PW, Sadove MS. Surgical separation in craniopagus. JAMA 1953; 153:201-7.

18. Aird I. The conjoined twins of Kano. Br Med J 1954; 1:831-7.

19. Mulcare RJ, Bhokakul P, Potitung P, Wheeler B. The surgical separation of the thoracopagus conjoined twins of Korat Thailand. Ann Surg 1970; 172:91-7.

20. Keats AS, Cave PE, Slataper EL, et al. Conjoined twins. A review of anaesthetic management for separating operations. Birth Defects 1967:3:80-8.

Downloads

Published

1995-12-29

How to Cite

1.
Suwatanaviroj A, Pring-Puang-Geo S, Watanatittan S, Havanonda S. Separation of Conjoined Twins : Children’s Hospital Experiences. Thai J Surg [Internet]. 1995 Dec. 29 [cited 2024 Jul. 18];16(2):33-40. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/250204

Issue

Vol. 16 No. 2 (1995): July - December

Section

Original Articles

License

Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.