Twins separated - for free
2010-04-30 08:38
Riyadh - An oxygen mask on his face, tiny 10-week-old Mohammed Taim lay still on a blanket but his conjoined twin brother Amjed was kicking and squirming - and not making work easy for the anaesthesiologists.
The doctors were readying the babies, fused at their bellies, for a marathon operation that they - and the boys' nervous Jordanian parents - hoped would enable the twins to live separate lives with separate bodies, each with their own full set of functioning organs.
The busy hands of a 25-strong team of Saudi doctors, led by Health Minister Abdullah al-Rabeeah, made it nearly impossible to see the infants on a screen relaying procedures in the operating theatre on Thursday.
For more than seven hours, the specialists worked the magic that has made them one of the world's foremost teams at separating conjoined twins, a relatively rare procedure that can eat up huge amounts of time and money - and which this team does for free.
Five hours on, having cut through the boys' shared sternum and halved their shared liver, Rabeeah administered the crowning touch. With an electric scalpel, he sliced away the final stretch of stomach skin and tissue joining Amjed to Mohammed.
Extremely tense
"Five, four, three, two, one," he chanted the final countdown. Swiftly the team pulled the two apart, bound their open wounds, and put them on separate tables where each were stitched up.
"The operation is complete, both twins are now in separate beds, both are stable," Rabeeah announced calmly.
The boys' parents, Yusuf and Hiyam, were visibly drained but managed smiles of relief after watching much of the procedure on the screens outside the operating room at the King Abdul Aziz Medical City on the edge of Riyadh.
"I was extremely tense," Hiyam said. "Especially when they were cutting the liver, it was terrifying."
Already a father of three girls and one boy, Yusuf Taim, a grocer in al-Zarqa, northeast of Amman, said he was shocked when his wife gave birth to the conjoined twins on February 15. But he knew where to turn.
With more than two dozen successful operations on conjoined twins, Rabeeah has built a reputation for himself and his country.
He took on his first separation surgery 20 years ago, a difficult case he recalls. "It took us months to prepare," and they were not fully confident.
Successes
"Luckily it was a success," he said.
Since then, with Saudi King Abdullah taking a strong personal interest in each case, sponsoring and paying for the operations, the King Abdul Aziz hospital and Saudi Arabia have become known worldwide for the procedure.
Today, it's proudly marketed.
On Thursday, large posters were hung outside the hospital with a picture of the two boys, happily sucking on pacifiers. "Jordan Twins Separation Operation", they announced. "Unlimited Humanity".
Conjoined twins are rarer than they once were, said Mohammed al Namshan, one of the surgeons on the team.
Pre-natal tests and pregnancy terminations in developed countries have sharply reduced the occurrence of conjoined twins, but in poorer countries the average is about one in 50 000 live births.
Of those, Namshan said, maybe half survive the first days or weeks, and only about half of the survivors are separable. The hospital has received 60 cases in total.
Twenty-three of them, like the Palestinian twins Ritaj and Rittal Abu Assi who came at the beginning of April, had major organ defects or impossible-to-divide organs and were thus unable to survive an operation.
Muslim modesty
But as of Thursday the hospital has chalked up 27 successes, 22 of them since 2003, involving twins from around the Middle East, Malaysia, the Philippines, Poland, Cameroon, and elsewhere.
"It is not just a medical challenge, it is a social challenge," the stocky, mid-50s Rabeeah said. "Our experience has made it very smooth."
The Taim case was one of their easiest. The boys were quite healthy at birth, weighing in together at 4kg, and mainly needed to double their weight before the operation.
They were joined from the sternum down to just above the navel, sharing the liver and possibly, doctors thought - ultimately incorrectly - some of the bowel.
The procedure began by putting coloured dots on the boys' foreheads, one got red and one got white, to be clear which doctors and nurses were to work with which boy.
After two hours of preliminaries putting them to sleep and attaching catheters and various vital sign monitors, little knitted lavender caps were put on the boys' heads and Rabeeah and his team got started.
"Please take the camera from the genitalia, don't show the private parts," he said in a bow to Muslim modesty.
Yusuf watched on a large screen as the doctors pulled, pushed and cut on his boys. "To tell the truth, I am afraid," he admitted.
But by the end it was all relief, though Yusuf said he still wasn't sure he would be able to distinguish them.
"At the first look, it was very strange to see them apart," said mother Hiyam, though she added that it quickly looked just right.
"Alhamdullilah" (praise God), she said.
- SAPA