▶️ Uganda's first Siamese twins surgery succeeds

HEALTH  | SIAMESE TWINS  | MULAGO HOSPITAL


It took 20 hours for 20 highly trained medical surgeons to separate two conjoined twins, in what has become Uganda's first successful Siamese twin surgery done within the country.

The team of surgeons, from different medical expert fields, entered the operating theatre at 8:00am on Monday, worked tirelessly throughout the night and emerged victorious with celebratory cheers at 9:00am, yesterday morning. However, before the critical 20 hours, the surgeons took 11 months to meticulously plan and prepare for the landmark surgery.



The planning started in December last year,when the hospital received the conjoined female twins. The twins, born of young peasant farmers from Kole district in Lango sub-region, were delivered through a caesarean section (C-section) by medics at Lira regional referral hospital.

The mother, Brenda Ajok (22 years), was referred to the hospital by Bala Health Centre, when she failed to progress in labour. Dr Rosemary Byanyima, the deputy executive director of Mulago Hospital, said after the C-section, Lira hospital medics referred the twins to Mulago for proper care.

Ajok, who speaks only Alur, smiled broadly while occasionally brushing her shoulders against her equally youthful husband, Bonny Ojuka's (26 years) shoulders, as medics spent 27 minutes recounting the landmark surgery.

As the medics were giving an account of the surgery on the lawn adjacent to the theatre, the twins, who will now grow and experience life separately, slept peacefully on separate beds covered in blue cotton bedsheets inside the theatre.

"Our team of paediatric surgeons and the nurses received them and took care of them. The babies looked nice and healthy, but as the lockdown came in, the couple requested to go back home. The team allowed them because they knew surgery would not be the immediate thing to do because they had to prepare," Byanyima told journalists yesterday, November 17, 2020.

Through follow-ups, Byanyima said, the doctors did everything possible to ensure that they were safe and healthy. "Around June, 2020 our team found out that the family had difficulty in feeding the babies. The babies had become malnourished. The mother's breast milk was not enough for the two. So, arrangements were made for them to come back for re-admission," she stated.

FUNDRAISING

Upon re-admission, the medics took it upon themselves to raise the funds for feeding of the twins and their parents. The fundraising was led by Dr Phyllis Kisa, a paediatric surgeon, who went as far as creating a WhatsApp group to lobby for funding.

Many well-wishers donated money and basic requirements for the family.  When the children recovered, Sekabira said they started preparations for the surgery. The children were also moved to the more spacious Mulago Specialised Women's Hospital. 



MEDICAL PREPARATIONS

The first medical examination was done in December last year. The surgeons carried out abdominal ultrasound scan and found that the hearts were separate, each child had two normal kidneys and the urinary bladders were separate. They also found that the 
rectum was shared towards the end and the twins were conjoined at the pelvis by the sacrum bone. The bone forms the lower back of the body.

"But at that time, we couldn't do further investigations because they were still neonates. We decided to mature them by giving them financial support, especially nutrition support to the mother," Sekabira said.

When the children recovered from malnutrition, Sekabira said they re-started the medical investigations to anatomically determine the shared organs. He said they did MRI (Magnetic Resonance Imaging) and CT scan to see the blood vessels shared. Both MRIs and CT scans view internal body structures. A CT scan is faster and can provide pictures of tissues, organs, and skeletal structure while an MRI is highly adept at capturing images that help doctors determine if there are abnormal tissues within the body. MRIs are more detailed in their images.

"We realised that they were sharing the sacrum, and this is a strong bone to separate. The rectum was fused at the end, but upward it was separate. We could not see a separate vagina. The uterus and urethra was also shared," Sekabira revealed.  

In September, the medics also put tissue expanders to expand the skin such that the excess can be used to cover the defects. The medics also did scoping by putting cameras in the rectal and vaginal opening to clearly define the inside anatomy. This was done on Friday last week.

"We found that one child had a vagina normally forming with a cervix and the other had no cervix. The rectum was separate inside, but closely fused with the vagina. Urethra was shared distinctively by both. So, we sat down and made a plan putting together all the required surgeons," he said.

The surgical team included orthopaedic (bone), vascular surgeons (blood vessels) and neuro (spinal cord) surgeons. The neurosurgeon was critical in ensuring that no damage is done to the nerves.

The team also had anaesthesiologists, radiologists (reviewing images and making decisions on what to do) and plastic surgeons, who made sure that after separating the twins, the defect is properly covered.

On Sunday morning, the twins were taken to the theatre at 8:00am and three hours were spent on anesthetising them. The surgery then started at midday, with the paediatric team first, followed by the orthopaedic team and then neurosurgeons and vascular surgeons. The separation was complete by 4:00am.

After this, the neurosurgeons started covering the open spinal cord and then the plastic surgeons did the finishing. The specialists left the theater at 9:00am yesterday morning. A colostomy and vesicostomy was also done to enable the twins pass stool.  

"When they grow up we shall be able to correct all those abnormalities and they will be able to live a normal life," Sekabira said.

However, he noted that one of the twins will not be able to conceive later in life, since she has no uterus. After six months or one year, the twins will again undergo another surgery, where medics will reconstruct the urethra and rectum, and construct a vagina for one twin. 



NOT THE FIRST SURGERY

It should be noted that this is not the first successful conjoined twin surgery to be done by Ugandan medics. The first one was done in Egypt in 2013. This was because the country had no facilities to handle such a complex operation.

"Surgery for conjoined twins is not a simple operation and most of the babies who are born conjoined rarely survive especially in Africa," Sekabira said.  

Dr Byarugaba Baterana, the Mulago hospital director, said this is a breakthrough and is proof that Uganda is now able to conduct complex medical operations in its own health facilities.

"In last year's manifesto, what was promised by government was the renovation of this hospital, as well as reducing referrals abroad. Such cases of Siamese, which would be referred abroad, are now done here," he noted.

Dr Byanyima appealed to pregnant mothers to always have at least two or three antenatal ultrasound scans so that such abnormalities are referred to appropriate health care level.