“The immediate post-surgery complication was that they were running temperature; it was malaria, we treated them and they are doing so well now.

“This is the first successful one at the hospital out of three that had been operated on,” Abdur-Rahmon, who is a Consultant Paediatric Surgeon, told PUNCH HealthWise.

The paediatric surgeon said the babies were delivered on August 31, 2020 through an emergency Cesarean Section at the General Hospital, New Bussa, Niger State, following a prolonged labour.

The surgery to separate the twins, however, took place on January 5, 2021 because the team members wanted to be sure of the best time to operate on the babies and to avoid post-surgery complications.

Explaining, Abdur-Rahman said, “The mother was attempting to deliver them vaginally, but got obstructed. So, they were referred from there to UITH after about 12 hours of labour. 

“When they came into the Neonatal Intensive Care Unit, we knew they came in a suboptimal condition, but the neonatologist in the team quickly resuscitated and treated them for an infection and provided the optimal environment for them to stabilise.

“The mother was referred to the gynaecologist, she was stabilised and transfused because she had lost so much blood,” Abdur-Rahman said.

The process

The don said the team had to investigate the twins, shared opinion, and got the required equipment before commencing the procedure.

“So, the journey started from there. We had to know where they were joined, what structures were joined and we started investigating them.

“Because they were joined at the chest and the abdomen, we had to do the echocardiogram to check if they shared any portion of the heart or any vessel crossing the heart.

“We also did a special doppler ultrasound to check if their livers crossed or not. We also checked the intestines.

“Then we did the CT scan to check the livers, the blood vessels, and the heart again. We checked the intestines to see if there was any point where they were communicating.

“So, as we went through all these, we had reliable information to see that there was no major connection between their organs,” he said.

Aside from studying the twins, Abdur-Rahman said the team had to wait for them to grow to enable the adult equipment to fit their state before the separation.

“The best of time to operate such patients is when you are certain that they are in a very stable condition; and determining the period will depend on which structures they are sharing so that by the time you are separating them, they will be comfortable staying on their own to minimise complications and damages.

“Though we had challenges with equipment, we adapted adult equipment in caring for them,” he added.

The team

Abdur-Rahman said the 66-member team comprised paediatric surgeons, anesthesiologists, paediatric cardiologists, neonatologists, psychologists, and technicians, among others. 

“From the time they came, we had to set up the multidisciplinary team, including neonatologist, paediatric cardiologists, anaesthesiologists, nurses, and workers from the blood bank.

“It involved the ethics committee; we got the clergy to speak with the parents, the psychologists to counsel them, technicians to work on the machines and put them in  proper state before we decided on operating them and even the hospital got independent assessors to review the babies and equipment and confirm that we could proceed,” he said.

Abdur-Rahman disclosed that the Ahmed Siamese twins were the third set of conjoined twins the UITH had attempted to separate, and that the latest effort was the first successful one.

“The first was in 2005. They were delivered in Odo-Ere in Kogi State and they were delivered prematurely in the 34th week of pregnancy by a 19-year-old teenager.

“She delivered them vaginally; they came in a critical condition. Doctors thought they could stabilise them, but the babies didn’t do well. One of them went down and an emergency surgery was done, but they both died shortly after the surgery.

“The second case was in 2016. The babies were joined at the chest. One of them was dying after 10 days of admission. Again, an emergency surgery was done but both were lost.

“But we thank God that this was successful,” he recounted.

Challenges

Abdul-Rahman said there were lots of challenges right from the time the mother and the twins were received in the tertiary facility.

“When they were referred, the parents thought the surgery was going to be done straight away; but we made them understand that they needed to be patient and prepare to have a good outcome.

“They were agitated, but they didn’t have the fund for the surgery, but the state government and the UITH management supported us.

“The father is an artisan and the mother is a hairdresser and they didn’t have the means, even to feed the babies. We had philanthropists who donated to get them to the optimal stage before the operation.

“It was tough but we thank God,” he said.

Abdur-Rahman added that with the successful surgery, the team is well-prepared for subsequent ones.

“This third one has stimulated everybody and made us well prepared. We had a good critique of the situation at hand.

“For me, as the team leader, there was a time everybody was waiting for me to convince them if we were truly ready to go ahead. So, I had to cross check with each team to know the problems they might be experiencing, all the while liaising with the management and other relevant persons to help with what we needed.,” he said.

According to Mayo Clinic, conjoined twins develop when an early embryo only partially separates to form two individuals.

“Although two foetuses will develop from this embryo, they will remain physically connected — most often at the chest, abdomen, or pelvis. Conjoined twins may also share one or more internal organs,” experts at the clinic said.

According to them, identical twins (monozygotic twins) occur when a single fertilised egg splits and develops into two individuals. Eight to 12 days after conception, the embryonic layers that will split to form monozygotic twins begin to develop into specific organs and structures.

“It’s believed that when the embryo splits later than this — usually between 13 and 15 days after conception — separation stops before the process is complete, and the resulting twins are conjoined.

“An alternative theory suggests that two separate embryos may somehow fuse together in early development.

“What might cause either scenario to occur is unknown,” the experts said.

source: Punch