Twins die after marathon surgery

Published on Tuesday 8 July 2003 01:00

TWO Iranian twins joined at the head died today shortly after a groundbreaking operation to separate them.

Ladan Bijani, one of two 29-year-old twins, died minutes after being separated from her sister by doctors in Singapore.

The dangerous operation left the other twin, Laleh, in a critical condition.

And sadness swept through the hospital when, a few hours later, she also passed away.

"Everyone upstairs is crying," said a nurse who was directly involved in the operation. "The second one has died. We treated them like family because they had been here for seven months."

Hospital officials had yet to officially announced the second death. Earlier they announced the death of Ladan, saying she had lost a lot of blood as the two-day surgery was coming to a close.

Surgeons began a marathon operation to separate the twins on Sunday afternoon - warning that the operation could kill one or both.

It was the first time surgeons had attempted to separate adult craniopagus twins - siblings born joined at the head - since the operation was first performed on infants in 1952.

News of Ladan’s death came less than an hour after hospital spokesman Dr Prem Kumar announced the twins had been separated, adding: "We should pray very hard for them."

Dr Kumar had warned that controlling the bleeding and moving the twins from a seated position onto separate beds would be the biggest challenge.

Remaining surgery for Laleh was expected to last at least another 24 hours as plastic surgeons covered her brain with tough, fibrous tissue taken from her thigh. The team of doctors had to contend with unstable pressure levels inside the twins’ heads just before they uncoupled the brains and cut through the last bit of skull joining them, Dr Kumar said.

Surgeons had separated the brains "millimetre by millimetre" Dr Kumar said earlier.

"They have to be teased apart very slowly," he said. "Cut. Teased apart. Cut. Teased apart. In the process, you encounter a lot of blood vessels and other tissues."

Yesterday, five neurosurgeons completed one of the most dangerous steps in the surgery by re-routing a shared vein and successfully attaching a vein graft from Ladan’s thigh.

The shared vein, thick as a finger, drained blood from the twins’ brains to their hearts. Their bodies are otherwise distinct.

Re-routing the shared vein was considered one of the biggest obstacles in the surgery. German doctors told the twins in 1996 that the surgery was too dangerous, but the Singapore team benefited from technological advances.

The operation was complicated further when the team discovered that the pressure in the twins’ brains and circulatory system was fluctuating.

Before the operation Ladan had said: "If God wants us to live the rest of our lives as two separate, independent individuals, we will."

An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery. The Iranian government had said yesterday that it would pay the nearly 180,000 cost of the operation and care for the twins.

The sisters were born into a poor family of 11 children in Firouzabad, southern Iran, but grew up in the capital Tehran under doctors’ care.

As girls they used to cheat on tests by whispering answers to each other, they said last month.