Surgical Experience with Thirteen Conjoined Twins

Abstract

Conjoined twins occur in approximately one in 50,000 or so births, and most do not survive. The authors report herein their experience with 13 conjoined twins over the last 30 years, involving those of the following forms: thoracopagus (4 cases), omphalopagus (1 case), ischiopagus (4 cases), pygopagus (1 case), craniopagus (1 case), and incomplete or parasitic varieties (2 cases). The various diagnostic and imaging studies used are described in detail for each form of twinning. Separation is best delayed until such infants are relatively mature (i.e., 6-12 months of age). Operative survival was 50% in those operated on in the neonatal period, but 90% in those over 4 months of age. Ten separations were attempted in 13 sets of twins, with 16 operative survivors. Significantly, up to 10 years after surgery, there were six late deaths due to serious associated congenital anomalies, predominantly cardiac. Improved recent survival is probably the result of the availability of more accurate imaging studies and better anesthetic and operative techniques, with great emphasis on performing immediate reconstruction whenever possible. Use of skin expanders and prosthetic mesh has facilitated wound closure. In the future, ex vivo cardiac reconstruction and autotransplantation may permit separation of twins with complicated conjoined hearts.

Epigastric Heteropagus Twins: A Case Report

“…As the name suggests, the parasite is completely dependent on autosite for its nutrition. This kind of twinning is extremely rare: one in 2 million live births [3]. The parasite is attached to the epigastric or hypogastric region of the autosite in most of the cases.…”

Medical Miracle in Indianola, Mississippi: The Untold Story of Dr. Clinton Battle and the Indianola Conjoined / Matthews Siamese Twins

“…They occur in approximately one in 50,000 or so live births [1]. The majority do not survive long-term [20]. Timing of operation and separation plan should be given according to the circumstances and the nature of the organ shared in each individual set of twins [8].…”

“…The timing of separation has been ideally set at between 5 and 9 months with 6 to 8 weeks of prior tissue expansion but earlier operation has frequently been required because of cardiorespiratory problems or organ failure in one of the twins. In most cases, the goal of obtaining separate, independent and intact individuals is achievable [20,21]. as conjunction is usually fatal, due to their association with major congenital defects.…”

Fetal Cardiac Magnetic Resonance (CMR)

“…Cardiac fusion is a very rare malformation that can be seen in twins conjoined at the level of the chest (Thoracopagus). Detailed evaluation of the degree of union and number of shared organs is required to predict the viability and prognosis of fetuses (O'Neill et al, 1988). In our series, fetal CMR helped in conjunction with ultrasonography in prenatal assessment of a thoracopagus conjoined twins with a shared eight-chamber heart and in a dicephalic twin with a shared 4-chamber heart (Fig.…”