Now the waiting begins for twins

Published on Tuesday 14 October 2003 01:00

SURGEONS who separated the conjoined twins Ahmed and Mohamed Ibrahim last night said it could be weeks or even months before they knew for certain whether the operation had been a success.

The two-year-old Egyptian boys were yesterday in a medically-induced coma and doctors said they were doing well after spending their first ever night apart since they were born joined at the head.

But medical staff said it was too early to say whether either twin had suffered brain damage during the operation.

"At this point, their vital signs are stable and we don’t see any signs that there have been any medical problems," said Dr Kenneth Shapiro, one of five neurosurgeons in a medical team of 60 assembled for the operation.

Dr James Thomas, the director of critical care at the Children’s Medical Centre in Dallas, where the boys were separated on Sunday, said the twins were doing very well.

"They had a very good night, they stayed in good shape, there were no major problems," he told ABC’s Good Morning America programme.

Dr Thomas said the big risks now facing the twins were of infection, for which the boys were being given antibiotics, and of post-operative swelling in the brain.

The twins will remain in their coma for several days as they begin the crucial post-operative period. Asked when doctors would know for sure whether surgery had been completely successful, Dr Thomas said recovery would be gradual and it could take weeks or even months before it was known whether any damage was suffered from the operation.

Dr Nasser Abdel Al, who was with the family for the marathon operation, said: "At one point, when someone came up and said, ‘You have two boys’, the father jumped to my neck and he hugged me and he fainted and I cared for him.

"He told me that he never dreamt of such a moment."

Dr Abdel Al, the head of neonatal surgery at the Cairo hospital where the twins were taken shortly after their birth, said Mr Ibrahim’s wife, Sabah Abu el-Wafa, was "crying like everybody else".

In the family’s home town of el-Homr, in Egypt, relatives last night expressed relief and villagers offered prayers of thanks after hearing that surgery to separate the twins had succeeded.

"I have been worrying and praying a lot for my grandsons and I am relieved to hear the surgery to separate them went well," said Mohamed Ibrahim, 65, the twins’ grandfather.

Worshippers gathered in village mosques offering prayers of thanks for the successful separation and hoping for the boys’ safe return.

"The hearts of all the villagers are attached to the twins," said Ahmed Abdel Basset, the imam of one of el-Homr’s mosques. "The villagers all feel the two children are like their sons."

The boys did not suffer major blood loss during surgery, said doctors, and there were no pulmonary problems and no significant or unexpected swelling in either of their brains.

As well as the risk of infection, doctors are on the alert for improper drainage of blood from the brains of the twins’ newly separated venous systems, leakage of spinal fluids and blood clots.

Neurosurgeons completed the most difficult and dangerous part of the operation on Sunday morning - separating the shared brain material circulatory systems that feed blood to their brains.

Cranial and facial surgeons finished the operation by repairing damage to the boys’ skulls, using tissue from an area around their thighs that had been expanded by balloon-like devices months before surgery.

The twins now face years of reconstructive surgery to repair the places where their skulls had been fused together, doctors said.

The operation’s initial success is a major breakthrough for the process of separating cranially conjoined twins, which suffered a set back in July when Iranian sisters Laleh and Ladan Bijahni, 29, died at a Singapore hospital from massive blood loss following an operation to separate them.

Doctors had said if the twins were not separated, they would likely never walk without help and faced a lifetime of medical problems.

They have spent almost all of their lives on their backs, which has left the rear of their skulls flat.

The conjoined boys, healthy, alert and playful, were more than 6ft long, measured from the toes of one twin to the toes of the other.

Twins conjoined at the head account for about one of every 2.5 million births and about 2 per cent of all conjoined births.