In an assertion of country’s growing medical prowess and what could come as a relief to many parents who have lost hope, a team of 40 doctors at BLK Super Speciality Hospital (BLK SSH) separated a Nigerian conjoined in a rare display of inter-speciality coordination and commitment.

The twin girls Hussaina and Hassana Badaru were 7-months 0ld when they were brought to BLK Super Speciality Hospital for separation. On their first birthday, they are happy, being apart and their parents can’t stop smiling. They are the first foreigner twins to be separated in India. The marathon surgery was carried out in 13 hours. A team of super specialists, including pediatric surgeon, neuro surgeon, plastic surgeon, pediatric critical care specialist, urologist, anesthetist, radiologists, spine surgeon, and hematologist, were involved in the successful separation of this pair of sisters.

Birth defects like the pygopagus twins, a phenomenon where the babies are joined at the sacral region and hips, occur rarely but are challenging to the medical world. The incidence of conjoined twins is high in south west Asia and Africa. The incidence in Nigeria is very high at 53 per 1000 deliveries.

The Badaru girls who are from Nigeria had the largest area that needed to be separated. Hassana and Hussaina, as they were named, were born at Murtala Muhammed Specialist Hospital, Kano last year. “Since BLK Hospital is very well known at Nigeria, they opted to do the surgery in India as the hospitals in Kano could not treat them,” informed Dr Praneet Kumar, CEO, BLK SSH.

When the twins were brought to BLK SSH, after initial evaluation and multiple rounds of discussions it was found that they shared their spinal cords, lower intestinal tract and genitory urinary tracts. This meant that they had one passage for fecal matter and one for passing urine.

Dr Prashant Jain, Consultant, Pediatric Surgery, who led the team in the surgery said, “A team of 10 specialities were involved in the surgery where they planned to do the separation in three stages. In the first stage, tissue expanders were placed to get adequate skin for covering the wounds after separation. Tissue expanders are essentially silicon bags which are gradually inflated with saline which are placed under the skin on the buttocks. By pumping in saline over a period of 2 months the tissue expanders were gradually inflated once a week. This helped in expansion of the skin and generation of good tissue cover.”

The second stage was followed by the actual separation of the spinal cords, intestine and genitor urinary tract which was carried out along with the reconstruction. In the same stage a temporary passage for fecal matter was created in both the sister’s abdomen which will be closed after two months.

Dr Jain added, “Separation of the ‘Badaru twins’ was a big challenge as they had unusual sharing of alimentary canal, genitourinary system and nervous system. We overcame this with meticulous planning and team work. Rehearsals were carried out using dummies and sometimes the girls themselves. Every surgical step was defined and rehearsed over and over again till it reached precision. The girls were color coded (one pink and the other blue) for 8 days before the surgery so that there would be no error at all. All tubes, wires, catheters, leads, syringes, injections and drugs were also color coded in accordance with the pink or blue code to avoid any error or miscalculation.”

The girls required warm fresh blood which was donated early in the morning by the hospital’s own staff. Two anesthesia teams were designated for each twin. The doctors’ task was made all the more difficult by the fact that both girls were healthy and equally developed. The team could not afford to compromise any organ or nerve when it came to separation.

“The most difficult task in this surgery was the anesthetist’s job which was challenging by the fact that whatever drug was given to one twin, the other would receive it inadvertently through a large sharing vein therefore it needed to be calculated and monitored carefully,” said Dr Kumar

The surgery lasted for about 12 hours and they were kept on ventilator support for 24 hours. Both the siblings are now stable and have shown no signs of any neurological deficit. The reconstruction was further carried out by giving them a new genito-urinary tract with new genitalia and their intestines were repaired with separate anal openings.

There could not have been better first birthday gift for these innocent girls.