Conjoined twins separated in 16 hours' surgery

In one of the rarest medical interventions in India, two-year-old twins joined at the head were separated during a 16-hour-long surgery performed by doctors at AIIMS which ended today.
The twins are on ventilator and their condition was critical, doctors said.
Odisha twins--Jaga and Kalia--were under observation and being monitored by a team of experts constantly. They are also being given blood, AIIMS Director Randeep Guleria said.
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.

A team of about 30 specialists from the institute's neurosurgery, neuro-anaesthesia and plastic surgery departments performed the marathon surgery which began yesterday at 9 AM and got over at around 3 AM today.
The babies were separated around 8.45 pm yesterday 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 Jaga was of more fragile health and his condition was more critical while Kalia was thought to be stable.
The twins, hailing from Milipada village under Phiringia block in Kandhamal district, are craniopagus conjoined twins, joined at the heads. This is a very rare condition, a senior doctor had said.
"Both the children have other health issues as well. While Jaga has heart issues Kalia has kidney problems. Though initially Jaga was healthier, now his condition has deteriorated. Kalia is better," Mahapatra said.
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.

The twins were admitted to AIIMS on July 13.
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 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.
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.