Conjoined twins separated in marathon surgery
Tuesday, 17 November 2009

Australian surgeons have separated Bangladeshi conjoined twins Krishna and Trishna in a marathon operation at a hospital in Melbourne.

After more than 27 hours of surgery that began at 8:30am local time on Monday, plastic surgeons at the Royal Children's Hospital have separated the Bangladeshi girls, aged two years and 11 months.

The hospital's head of surgery Leo Donnan praised his team of doctors, who he said had worked seamlessly to separate the girls.

"This is a once-in-a-lifetime operation that teams would do," Donnan told Australian reporters outside the hospital.

"There's relief and it's nice to know we're on to the next stage rather than the previous stage we were at.''

Donnan says the Bangladeshi twins still have a very difficult time ahead of them.

"The girls' physiological condition has improved over the operations, but their bodies now have to recover. Everything is in place for the best possible outcome.''

With the plastic surgeons completing the surgical work, Donnan declined to say when the operation would be declared finished.

"I'm not going to put any timeframe on it," he said. "However long it takes is how long it takes."

The reconstructive surgery is expected to take a number of hours.

Earlier, as the surgery neared the 24-hour mark, Ian McKenzie, the hospital's director of anaesthesia, emerged from theatre at 8am to report that "the kids are going very well" but were still to be fully separated.

The operation was initially expected to take about 16 hours. The longest operation to separate conjoined twins joined at their head took four days in April this year in Singapore.

Dr McKenzie said that while progress might appear slow, it was "very fiddly work" and the operation was going "better in some ways" than expected. The girls' conditions had strengthened as the operation proceeded, he said.

"A lot of things we were worrying about haven't happened," he said, but added "it's not over yet".

"You've still got potential for life-threatening things happening." He said concerns over problems with Krishna's kidney had eased.

The Bangladeshi orphans were given just a 25 per cent chance of making it through the operation without harm. The hospital's experts considered some level of brain damage a 50 per cent chance, and death was also a significant possibility.

McKenzie could not predict when the surgery would be finished.

''The twins are actually in better condition because the degree of separation has increased. The problem of their circulation affecting one another is actually less,'' he said.

Dr McKenzie said the handover to the cranio-facial plastic surgery team was "getting pretty close". "That is a critical part of the surgery ... There's quite a lot of steps in that, and they each sound pretty simple, but they've each got their own issues," he said.

While he was still optimistic about the outcome of the marathon surgery, he said "we're keeping the cork on the champagne".

"Now we have the long task of the reconstruction surgery which will go on for many hours,'' he said.

"But what I can say is that everything we have done has gone successfully and we are very happy with the way it has been going for these girls," said McKenzie.

The Children's First Foundation, an NGO working for children, brought the Bangladeshi conjoined twins to Australia for the operation.


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