7th April, 2010: The preparation for the surgery started two days ago with the kids being given blood transfusions to build up their haemoglobin which was low, cleansing of their intestines and urinary tracts to prevent post operative complications. Pre-operative work up was done in a systematic and detailed manner with extensive blood test, ultrasounds, high resolution CT Scans & MRIs with 3D reconstruction of the same. Radio nuclear renal scans with fractional functions of the kidneys were also done. Nutritionally the children were built up before surgery. The combined weight of both the children was 12 Kg. These conjoint twins were fused with a lower part of the pelvis, spine, hip bones, legs with a common intestinal tract and common genito-urinary tract. These are genetic defects at a embryonic level with it being very rare. Very few cases have been successfully been operated upon worldwide in the 50 years and just a handful in India stated Dr. Sanjeev Bagai, CEO, Batra Hospital & Medical Research Centre.
The surgery started at 7:00AM on 5th April, 2010, with both children being given anaesthesia separately but simultaneously. The surgery lasted for 14 hours.
After putting the children to sleep central lines were put into the major vessels to monitor body functions as blood pressure, heart rate, central venous pressure and to give fluids and blood as required – stated Dr. Pawan Gurha of Critical Care.
The children were then made to lie on their abdomen and the surgery was started from the back. After making the skin incisions, the skin flaps were raised.
The lower ends of the spinal column were united which were separated gradually with infinite care so as not to damage any nerves.
“After separation of the spine, the pelvis opened. Both the intestines were joined and had a common anal opening. Both the intestines were then separated and the anal canal was split in the middle to give each child an independent and functional opening to pass stools”,said Dr. Arvind Sabharwal – Paediatric Surgeon.
After that the vaginas were separated which had a common wall which was just 2-3mm thick. With infinite care and patience the common wall was split and two vaginas were created stated Dr. Rohit Nayyar – Plastic Surgeon.
Both the urethras were lying intimately close to the vagina. Both the urinary openings were then separated by Dr. P.P. Singh, Urologist.
Then both the children were turned on their back and the rest of the dissection to separate the muscles and the bones of the pelvis was carried out.
The separation took about five hours.
Then the children were moved onto two different operation tables and the reconstruction work was started. The new anal opening, the opening of vagina and the urinary tract were reconstructed to give a normal appearance. The shape of the external genitalia was brought to normal. Then the skin flaps were constructed and the whole skin defects were closed successfully.
The total time taken was about 15 hours.
8 Surgical teams of 27 total specialist and 12 dedicated nursing staff worked on these children simultaneously. This has been a phenomenal success story not only for the Batra Hospital & Medical Research Centre, but also for the Indian Medical Fraternity which has truly made rapid strides to be world leaders in healthcare. The full medical team was of Batra Hospital full time doctors, which are world leaders in human intellect and clinical skills – stated Dr. Sanjeev Bagai, C.E.O. The children are now being observed in the paediatric intensive care for close monitor and care. This surgery could be a revolutionary path breaker for high end specialized surgical procedures in children – said Dr. Bagai.
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