KZN Health MEC, Dr Sibongiseni Dhlomo acknowledging and appreciating the miraculous and ground-breaking operation conducted to separate conjoined twins at Inkosi Albert Luthuli Central Hospital

17 March 2017

On behalf of our Premier; Honourable Willies Mchunu, I have been tasked to convey our citizens' gratitude and appreciation to the team of Specialists that successfully carried out this operation.

I will start with a brief background to this good ending story. In October last year at a rural area of Pongola, a 31 year old mother of 4 gave birth to a conjoined twins in a delivery that was conducted by family members at home under very simple circumstances. When the baby girls were found to be conjoined twins, together with the mother, they were taken to the local Itshelejuba Hospital and then transferred to Lower Umfolozi War Memorial Hospital (LUWMH) at Empangeni. It was here that they were assessed and found to be joined at the chest and abdomen and immediately transferred to the Neonatal Intensive Care Unit (NICU) at Inkosi Albert Luthuli Central Hospital for further management.

In this first class facility they were subjected to various investigations that included X-rays; cardiac echocardiograms; CT scans and CT angiograms. It was found that they shared a common pericardial sac with a possibility of a shared myocardium and that they also had fused livers.

Specialist Team led by Dr Harshavan Mackanjee, Chief Specialist –Paediatric Medicine
Specialist Team led by Dr Harshavan Mackanjee, Chief Specialist - Paediatric Medicine

One good feature was that their gastro-intestinal tracts were completely separate which made it was possible to feed them.

A decision was made after discussions with the paediatric surgical team and the cardiology team to continue conservative management until the twins attained a combined weight of approximately 10 kg - before any operation was considered. They have since been kept at the Neonatal Intensive Care Unit where they were fed enterally and having their growth patterns recorded.

All along the parents were given continuous support and counselling by the team of doctors, nurses and social workers.

At five months they were assessed and found to have attained a combined weight of 9.7kg and then given further evaluations regarding cardiovascular and hepatic systems. Plastic surgery consultants also evaluated the necessary procedures required to obtain closure of the chests and abdomens after separation. Consultations here also involved Cardiothoracic Surgeons and Anaesthesiologists.

Crucial at this stage was constant and numerous discussions with both parents on the prognosis that were undertaken. Possibilities of both morbidity and mortalities both during and after the operations were discussed were also pointed out.

The team consisting of Neonatologists; Paediatric Surgeons; Cardiothoracic Surgeons; Cardiology; Anaesthesia; Plastic Surgeons; Nursing staff; Theatre staff, and Hospital management then started planning for this ground breaking separation operation, with Theatre set-up discussed in detail.

The date of the separation was planned for 11 March 2017 and practice runs were done both a week before and a day before the operation to ensure correct and meticulous set-up in theatre.

It was decided that the entire day, on the 11th of March 2017 would be dedicated to the planned separation.

On that day, the babies were intubated, ventilated and anaesthetised and then the thoracic cavity was opened. The Specialists were happy and relieved to find that the hearts were separate which meant that the twins did not require cardio-pulmonary bypass. What needed separation, amongst others, were the livers, in an operation that was successfully performed by the Paediatric Surgical Team.

The operation was then completed by the Plastic Surgical Team who used various techniques to ensure closure of the thorax in both the twins. The entire operation spanned 13 hours and the babies were returned to the Neonatal ICU in a stable condition. The first 24 hours post-op were uneventful.

This morning, one was weaned off from the ventilatory support and she is breathing on her own. The one still on ventilator showed signs of missing the other and was provided with mirror on her cot to create an impression that the other was still around. Both are expected to be out of intensive care within the next 4 weeks.

Our gratitude again go to all the Specialists teams who amassed all their experience; acumen and expertise to successfully carry out this delicate; life threatening and precarious ground breaking operation.

Indeed, it is only in a public health care institution that such a team of Specialists can be mobilised and assembled to perform a surgical operation of this nature at no cost to the patient.

ENDS

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