Conjoined twins: surgical separation in 11 cases
Sukawat Watanatittan1, Rangsan Niramis, Anant Suwatanaviroj
1Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
Insights
Surgical separation of conjoined twins, including omphalopagus, thoracopagus, and pygopagus types, showed varied outcomes. While elective separations generally had better survival rates, early emergency separations due to twin deterioration or complex cardiac anomalies had higher mortality.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Surgical Outcomes
Background:
- Conjoined twins present unique surgical challenges.
- Surgical separation is often necessary for twin survival and quality of life.
- The Queen Sirikit National Institute of Child Health has experience in separating conjoined twins.
Purpose of the Study:
- To analyze the outcomes of surgical separations of conjoined twins.
- To compare results between emergency and elective separation procedures.
- To identify factors influencing survival rates in conjoined twin separations.
Main Methods:
- Retrospective review of 11 cases of conjoined twin surgical separation.
- Classification of twins by type (omphalopagus, thoracopagus, pygopagus) and sex.
- Categorization of separations into emergency/semi-emergency and elective procedures.
Main Results:
- Six omphalopagus, 4 thoracopagus, and 1 pygopagus pair were separated.
- 3 pairs underwent emergency/semi-emergency separation; 8 pairs had elective separation.
- Early emergency separations for critical conditions had higher mortality, especially with cardiac anomalies. Elective separations had better survival, though one late mortality occurred.
Conclusions:
- Surgical separation of conjoined twins can be successful, particularly with elective procedures.
- Early emergency separation in critical cases carries significant risks, especially with complex cardiac anomalies.
- Careful patient selection and timing are crucial for optimizing outcomes in conjoined twin surgery.
Abstract:
Eleven pairs of symmetrically conjoined twins underwent surgical separation at the Queen Sirikit National Institute of Child Health. Six were omphalopagus, 4 were thoracopagus and 1 was pygopagus. Eight were female and 3 were male. Three pairs were separated on emergency or semi-emergency bases, and the remaining 8 pairs were separated electively at an older age. Of the 3 pairs who had early emergency separations, one pair, whose combined birth weight was only 2,500 g, underwent emergency separation at the age of 44 days after the death of one twin. The second twin also expired one hour after the separation. In the remaining 2 pairs, early separation was done because of the deterioration of one twin due to complex cardiac anomalies. In both cases, the infants with cardiac anomalies expired but the others survived the separation satisfactorily. In one pair of thoracopagus conjoined twins, one twin had cyanotic cardiac anomalies. They were electively separated at the age of 2 years and 9 months. The twin with cardiac anomalies expired 2 hours after surgery, but the other survived the separation satisfactorily. In the remaining 7 pairs who underwent elective separations, both twins of each pair survived the separation satisfactorily. However, one twin expired unexpectedly 10 days after the separation.
