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Surgical experience with thirteen conjoined twins.

J A O'Neill1, G W Holcomb, L Schnaufer

  • 1Department of Surgery, Children's Hospital of Philadelphia, PA 19104.

Annals of Surgery
|September 1, 1988
PubMed
Summary
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Conjoined twin survival rates significantly improve when surgical separation is delayed until infants are 6-12 months old. Advances in imaging and surgical techniques enhance outcomes for these rare births.

Area of Science:

  • Medical research
  • Pediatric surgery
  • Genetics

Background:

  • Conjoined twinning is a rare condition affecting approximately 1 in 50,000 births, often with poor survival rates.
  • This study reviews 30 years of experience with 13 cases of conjoined twins, encompassing various types like thoracopagus, omphalopagus, ischiopagus, pygopagus, craniopagus, and parasitic twins.

Observation:

  • Diagnostic and imaging studies were detailed for each twin type.
  • Surgical separation outcomes were analyzed based on the age of the infants at the time of operation.
  • Long-term survival was assessed, noting late deaths primarily due to congenital anomalies, particularly cardiac issues.

Findings:

  • Delayed separation (6-12 months) yielded a 90% operative survival rate, compared to 50% for neonatal procedures.

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  • Ten separation surgeries resulted in 16 survivors, with six late deaths within 10 years, predominantly from cardiac anomalies.
  • Improved survival is attributed to advanced imaging, anesthesia, and surgical techniques, including immediate reconstruction and use of skin expanders/prosthetic mesh.

    • Implications:

    • Optimal surgical timing is crucial for improving conjoined twin survival rates.
    • Continued advancements in medical technology and surgical approaches are vital for managing complex congenital anomalies.
    • Future strategies like ex vivo cardiac reconstruction and autotransplantation may offer solutions for separating twins with intricate cardiac connections.