Midday, February 5, 2023 has been entered into the country’s medical book of records.
It had been 15 hours of patience, precision, a complicated and delicate operation that involved a number of fragile surgeries on siamese twins joined at the abdomen and chest.
The twins, now lying at Kenyatta National Hospita (KNH) Intensive Care Unit (ICU), under close monitoring and treatment and progressing well, had to undergo several surgeries including; a heart, bone, skin, liver, several muscles, peritonia, and the chambers that encase the heart.
It was the work of a team of 38 pediatric specialists from KNH and the University of Nairobi’s (UoN) pediatric surgery department, successfully separating the twins, a procedure that included a triumphant liver transplant.
“This is a milestone,” Kenyatta National and Teaching Referral Hospital Chief Executive Officer, Dr. Evans Kamuri told journalists at the Level 6 facility’s boardroom on Monday evening.
The team, of multi-disciplinary medical experts was led by paediatric surgeon Dr. Joel Lessan.
The operation began on Saturday night at 10 pm and ended on Sunday at midday. But according to Dr. Kamuri, the surgery was necessitated by a number of aspects as the twins had started developing complications.
The team had 24 surgeons including Plastic and Reconstructive (5), Pediatric Surgeons (14), Anaesthetists, and Cardiothoracic (1)) as well as six nursing officers.
“The patients were referred to us, and immediately we set up a team to carry out a thorough investigation to understand the conjoinment before embarking on the actual surgery which took 15 hours,” an elated Dr. Kamuri revealed.
The twins have been under observation since September last year.
Doctors described their condition as ‘Thoracobnominocophagus’, a situation where twins are joined face to face at the chest and abdomen.
When they came in, they were taken to the High Dependence Unit (HDU) for oxygen support. One of them had multiple holes in the heart, while the other one had abnormal blood vessels.
“We needed to stabilize them first,” Dr. Lessan said.
He described the surgery as complex since even one of them had contracted Covid-19, and at that age, the specialists needed to think and act carefully, to save their lives.
According to Dr. Lessan, the decision to operate on them came on Saturday night after one of them suffered a cardiac arrest calling for a swift yet calculated move on how to save their lives.
He said both children had multiple holes in their hearts, with one of them having an abnormal blood vessel originating from the heart.
This, he said, was compounded by a life-threatening infection at two months that was diagnosed and treated early enough.
Even though the target time for safe separation was to be at six months, one of the twins, he said, developed high pressure in the lungs, exposing them to even greater danger including imminent heart failure.
“This informed our team, even at four months, to start plans for separation. The challenge at this level was how to cover the defects left behind on their line of separation,” he said.
He added: “However, last week on Thursday, we successfully developed flaps to cover the separation lines. We were to wait for another eight weeks before attempting complete separation. Unfortunately, two days after raising the flaps, one of the twins suffered a heart attack. He was, however, successfully resuscitated.”
“We made an emergency decision to separate the twins because subsequent cardiac arrest would put the lives of the other twin in danger, hence. We mobilized the team, equipment, and medication culminating in the successful surgery on Sunday,” he said.
Conjoined twins are the result of embryo cells that have not completely separated. Embryo cells develop when the egg (ovum) is fertilized by sperm. They multiply and differentiate to form different body organs and tissues. An alternative theory is that two separate embryos fuse in the early development of twins.
The exact cause of conjoined twins is unknown but it’s thought that genetic factors interacting with environmental ones may contribute. Another possibility is the medicines taken by the mother during pregnancy.
This type of conjoined twins often has a shared heart and may also share one liver and the upper intestine.
This is one of the most common sites of conjoined twins globally.
In this case, the twins shared a liver and had two hearts in one cavity. Both hearts were abnormal.
They similarly shared chest bones and muscles. In such cases, patients require close monitoring and treatment before a decision of their separation is duly agreed.
KNH’s Director of Surgical Service Dr. Kennedy Ondede attributed the success of the operation to surgical dexterity, teamwork, and dedication by the multi-disciplinary team.
“Proper planning, expertise, and careful preparation of the various sub-specialties is a critical part of this kind of surgery,” said Dr. Ondede.
Dr. Evanson Kamuri hailed the KNH team for yet another milestone.
“This is a landmark. On this historic day, we have achieved yet another achievement in fulfilling our mandate as a top premier referral hospital,” he said.
“It was just amazing to see one set of conjoined twins turn into two separate children. We are dedicated to ensuring that their follow-up care nurtures them into happy and healthy children. The KNH team seized the moment against all odds. We celebrate their dedication to achieve this incredible milestone today,” Dr. Kamuri concluded.
Dr. Kiboi Julius Githinji applauded the multi-disciplinary approach employed and noted that in the next few years, Kenya is going to mark territory in liver transplant and other delicate surgeries.
