On Sept. 11 a team of 20 surgeons, anesthesiologists, and nurses successfully separated the two Nigerian conjoined, or Siamese, twins Faithful and Favor Sobowale-Davies, who were joined at the chest and stomach and shared a liver.
The six hour surgery, lead by the Director of Pediatric Surgery of the Children's Center Dr. Paul M. Colombani and by Dr. Henry Tien Lau, was completed after separating the twins where they were joined at the sternum and abdomen.
Classified as Thoraco-omphalopagous, the Sobowale-Davies twins fall in to the most common category of conjoined twins as this type makes up one-third of all conjoined births. Conjoined twins, however, are very rare, only occurring once every 70,000 to 100,000 live births. Surgeons speculate that the abnormality might normally cause miscarriage, thus lowering the number of conjoined births.
Conjoined twins form in a different way than twins separated at birth. To being with, the developing embryo begins to split into identical twins but then stops part way leaving the partially separated egg to mature into a conjoined fetus.
They are more often female than male, with no particular scientific explanation. The conjoinment, according to the New Scientist, may also be formed by genetic and environmental conditions, which are responsible for the failure of twins to separate after the 13th day after fertilization.
The mortality of newly birthed conjoined twins is alarmingly high. Forty percent are still born, and 75 percent are either still born or die within the first 24 hours of living. Fortunately, this is rare.
There are several types of conjoined twins. The most common type is when the twins share part of the chest wall and possibly share the heart. Conjoined twins can also share a hip, and other body parts. It has been a rare occasion when twins share a brain, but several cases do exist.
The separation of twins is a selective process. Based on the life expectancy and other factors ranging from feasibility of the surgery, to pre-natal care, choosing which twins will be separated is essentially left up to hospitals and other research organization. The surgeries are costly and as told, take a long time.
The twins, who are now in their third month of life, were only discovered to be conjoined when their mother, Kikelomo Sobowale-Davies a secretary of Lagos, Nigeria, delivered them by cesarean-section this summer.
After initial discussion between the Sobowale-Davis family doctors in Nigeria and surgeons here at Johns Hopkins Children's Center, the decision was made to bring the twins to Baltimore for separation. Dr. Colombani said that he and the other surgeons at Hopkins were "happy to help in any way."
A series of pre-surgical consultations allowed the surgical team to devise a detailed plan for the separation. A CT scan of the twins provided detailed information as to what organs were shared between Favor and Faithful. The team staged two separate mock operations to practice the procedure, and divided themselves into two teams, Yellow for Favour, and Red for Faithful.
The most difficult part of the surgery, according to Dr. Colombani, was the division of the liver, which was possible due to its ability to partially regenerate itself. The "liver ... is pretty much the most critical part of the operation because of the bleeding that can occur," said Colombani in a Sept. 16 press conference. The division was possible because of technology that enables surgeons to limit that bleeding in living tissue. This is another example of technology developed by scientists to help in human survival.
After the separation, the Faithful and the Red team moved to an adjacent operating room. Surgeons then closed the incision that separated the twins. The twins were both able to be closed with their own tissue, and required no skin grafts or artificial abdominal walls.
All the personnel involved in the operation waived their customary fee for their time and effort, which was estimated by Dr. Colombani to have potential cost of up to $20,000. The other expenses involved, estimated at $20,000 to $25,000, have been covered by donations to the hospital by a group of benefactors.
At the Sept. 16 press conference Abayomi Sobowale-Davies, the father of Favour and Faithful, thanked God, the surgical team and numerous others who helped make the surgery possible.
Physicians plan to let the twins recover from the surgery until the end of the month, and which point they will be able to return to Nigeria. Mr. and Mrs. Sobowale-Dabies also have two other children, both girls, ages 4 and 6.
