Mulago National Hospital Conducts Successful Separation of conjoined twins

A team of 20 specialists at Mulago National Specialized hospital have successfully separated 11-month-old siamese twins.

Dr Philis Khisa, one of the doctors involved in the operation said that the process started last week with an investigation technically known as, scoping where they had to identify the exact organs that the twins shared.They found that the two girls had one vaginal opening although inside they had separate organs. Also, they found that the twins were conjoined at the pelvis, at the large bone called the sacrum.

Dr John Sekabira, a consultant paediatric surgeon who led the team, told journalists on Tuesday that the siamese twins’ rectum was fused at the end, they didn’t have a separate vagina, shared a urethra and the spinal cord was joined at the tail end.

“The rectum, we realized that it was somehow fused at the distal end but upwards it was separate. And the vagina, you could not see a separate vagina, the uterus you couldn’t demonstrate and the urethra – that is the passage of urine from the urinary bladder was shared. So from then on, we formed a team of specialists of orthopaedic surgeons – that is surgeons who operate on bonds, vesicular surgeons who operate on blood vessels, neurosurgeons because the spinal cord was also joining together at the tail end,” said Sekabira. 

The operation that started at around midday on Monday ended at 9:00 am the next day, with the doctors referring to it as one of the most complicated procedures which have to be done slowly and carefully since it also involved separating blood vessels.

“Immediately we got them, we did abdominal ultrasound which is the easier investigation to do. We found that the hearts were separate, they each had two kidneys, they had separate urinary bladders but what was striking is that you couldn’t follow properly where their rectums were – they were conjoined at the pelvis at the bone called the sacrum,” added Sekabira. 

 The separation of the babies didn’t happen until 4 am according to Dr Khisa, adding that this is a major milestone as the children had been kept under monitoring since December 21 when they were referred from Lira hospital three days after birth through a caesarean section operation. 

During the lockdown in April, the couple requested to go back home following a halt in non–emergency health services.“Unfortunately the children got malnourished. The parents could not afford proper feeding so we had to treat this before embarking on this operation,” Dr Khisa added. 

In September, they started the early processes with plastic surgeons putting them on tissue expanders which were used to cover the defect. Sekabira says the babies are to remain admitted in the hospital for six months to one year as they await another surgery to correct other tissues like the reproductive system such that each can live healthily on their own.

However, conjoined twins especially in African countries like Uganda rarely survive, and when they survive they usually don’t survive beyond the surgery. Uganda’s first conjoined twins to survive were operated on seven years ago in a surgery that was conducted in Egypt.

Dr Byarugaba Baterana, Mulago hospital director says the earlier operation was conducted by Ugandan doctors who travelled abroad because the country didn’t have the necessary equipment for the operation which can go in the highs of $10,000 in countries like India and much higher in the West.

The operation which is also the first to be conducted at the new super-specialized theatre facility was conducted free-of-charge during their test running initiative before fully opening for other tertiary operations like organ transplants.

Annually, 3 to 4 siamese twins are referred to Mulago hospital, but many times they only have to do emergency operations. For instance, recently Dr Sekabira says they had to conduct an operation on twins where one died.  The other twin didn’t survive the operation either.