In a first for India, twins joined at the head, separated at AIIMS
Gupta had earlier said the condition, which the twins suffer from, afflicted one in 30 lakh ...
Gupta had earlier said the condition, which the twins suffer from, afflicted one in 30 lakh children, of which 50 per cent die either at birth or within 24 hours. In the country, two similar surgeries had taken place earlier to separate twins joined at the head but were not successful as the children died during the procedure.
The most challenging job after the separation was to provide a skin cover on both sides of the brain for the children as the surgey had left large holes on their heads. "The skin was generated from the expansion of two balloons which were placed in their heads during the first surgery. If the twins make it, the next step will be reconstructing their skulls," Maneesh Singhal, professor and head of plastic surgery at AIIMS. Neurosurgeon Deepak Gupta, who played an important role in the surgery, said the twins also had seizures during the procedure which had to be taken care of by the operating team.
The first phase of the surgery was performed on August 28 when the doctors created a venous bypass to separate the veins shared by the babies that return blood to the heart from the brain. Elaborating on the challenges faced during the surgery, the medical team said each of the children required 20 units of blood. "There was a situation in which one of the kids did not have blood nerves which had to be created. The skin grafting was also done and later extra care had to be taken for the blood, nutrition and overall health of the two so that they could sustain during the surgery," said Guleria.
The twins hail from Milipada village under Phiringia block in Kandhamal district. "Both the children have other health issues as well. While Jagga has heart issues, Kalia has kidney problems. Though initially Jagga was healthier, now his condition has deteriorated. Kalia is better," Mahapatra said.
The specialists from the institute's neurosurgery, neuro-anaesthesia and plastic surgery departments performed the marathon surgery which began on Thursday at 9 am and got over at around 3 am on Friday. The babies were separated around 8.45 PM and the covering of the brain using skin flap and graft took 4-5 hours. One of the babies was shifted to ICU at 11.45 pm and the other baby at 2.30 am, a statement said. Mahapatra said Jagga was of more fragile health and his condition was more critical while Kalia was thought to be stable.
AIIMS Director Randeep Guleria said though the 28-month-old twins have been separated, the next 18 days would be extremely critical to ascertain the success of the surgery. The team of doctors involved in the procedure also seemed concerned about the survival of one of the twins, citing his deteriorating health. "The children have been separated. There were many challenges in this surgery which we have never seen before. During the surgery a total of 3.5 litres blood was also lost," A K Mahapatra, the chief of the neurosciences centre at the AIIMS said.
Since 1973, only 60 such surgeries have taken place across the world. The last one was reported from Philadelphia in June this year. Out of every 3 million children, only one pair is conjoined; and of all conjoined twins, only 2 per cent are craniopagus. There is a less than 20% chance of survival among craniopagus twins undergoing surgery, data shows.
A team of 40 doctors from over 12 different super-specialities operated on the twins from Milipada village in Odisha. The twins, who were admitted to the hospital on July 13, were born with an extremely rare condition — joined at the top of their heads, with their bodies at 180 degrees to each other.
AIIMS said Jagga and Kalia, who underwent an 18-hour-long surgery, are "critical" and that they are on ventilator support.
All India Institue of Medical Sciences (AIIMS) on Thursday successfully conducted India's first 'craniopagus surgery' to separate 28-month old twins from Odisha, who were joined at the head.
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