A team of doctors from the Oshen King Faisal Hospital have separated a pair of seven months old pair of conjoined twin girls, marking the first successful operation of this nature in the country.

Babies Liliane and Diane were born to a 30 year old woman who hails from Huye district. Besides episodes of dizziness of the mother, the pregnancy was uneventful and the she had followed her antenatal care all through.

Conjoined twins is a condition where two people with the same mother are born at the same time with of their body parts joined together.

According to Dr. Edmond Ntaganda, a pediatric surgeon who led the team of surgeons through the surgery, the girls were born facing each other and were joined from the chest to the abdomen.

However, even with imaging and other tests, it was challenging to tell exactly what organs the two shared internally.

"The initial investigation showed that they were sharing the liver which was the main component of their shared organs and it was not clear at the time if they shared parts of the heart. They clearly had two hearts but it wasn’t very clear from the imaging if they were sharing the wall or the envelope of the heart,” he said.

However, as more tests were being done as the referral board searched for a hospital outside the country with more advanced facilities and experience in separating conjoined twins, one of the girls fell sick.

Dr. Tharcisse Ngambe, a pediatrician who had been involved with the twins from the time they were born said that even with treatment, the sick twin; only identified as Liliane, was not responding to treatment and a decision had to be made fast on separating the twins or risk losing both of them.

"The initial plan was to offer treatment and send them back home as we waited for the referral board to find a center where the operation would take place. However, while Diane, one of the other twins was strong, Liliane’s condition was worsening and she started having multi-organ failure. It’s then that it was decided to separate them so that at least one of them is saved,” he said.

The operation

Dr. Didace Mugisa, a cardiothoracic surgeon who was also part of the team says that it was team effort because there was need for different expertise based on the issue at hand.

For instance, he said that while Liliane was incubated and breathing through a machine, Diane was breathing on her own and had to be put to sleep before the surgery.

He pointed out that the first win for the doctors that upon opening Liliane’s chest, their worst fear was put to rest since it was discovered that the girls’ hearts were completely separate.

"Our incision was made more on Liliane who was losing use of her organs so that we can preserve skin to cover the defect. We immediately discovered that the hearts were completely separate and individual. It was very good news because one of the biggest challenges when having such an operation is when the heart is involved,” he said.

Dr. Mugisa explained that if the heart is involved, doctors very often find it difficult to separate them successfully or need to do a heart transplant immediately.

"Even if you manage, the complications are very many and if it’s one heart, you may be required to make a decision to give it to one of the babies,” he said.

Upon closing up the chest, the doctors moved on to the abdomen where they were required to determine what percentage each girl had.

The doctors knew that they girls shared a liver but they were not certain what percentage of the liver they shared. Upon opening them up, they were relieved to find out that the bigger part of the liver was on baby Diane’s side which was also good news.

They girls also shared a small gut, and a small part of the bowels.

The entire operation took a total of eight hours.

Bittersweet experience

While the doctors were proud of their achievement, baby Liliane did not make it and was pronounced dead.

Baby Diane who is in stable condition and off ventilation is expected to remain in intensive care for the next few weeks for observation.