The Times on Saturday 10/12/11 published its top British Surgeons list and I was thrilled and honoured to be included in the list alongside my friend and colleague Owase Jeelani, consultant neurosurgeon. The article about us was centred on our recent successful separation of the Sudanese conjoined twins Rital and Ritag. The separation of the twins, was a tremendous success and represents one of the very few successful separations of craniopagus (joined at the head) twins in the world.
In reality, extraordinary events like this are built on the experience of others and the existence of dedicated teams of clinicians and professionals in the healthcare sector.
Our craniofacial team is situated at Great Ormond Street Hospital for Children, which I think is probably one of the few institutions in the world that is able to support a team able to plan and carry out complex procedures such as these.
The road to separation was long and involved. The first task involved working out how they were joined together which involved some quite complex radiology. By the time the twins had had MRI’s, CT scans and angiograms the team was able to establish that Rital and Ritag’s brains were separate but that they shared some important veins. The information provided, allowed us to make a detailed plan for a staged separation, which in the end turned out to be based on very accurate information.
Sharing major blood vessels in the head led to many other unexpected consequences. The circulating blood was flowing predominantly through Ritag which meant that her heart and kidneys were overloaded. In effect, she was doing the work needed to survive for both twins. This caused heart failure and renal problems needing expert cardiological and renal intervention. The fact that both twins shared a blood supply caused problems for anaesthesia, because anaesthetic drugs given to one twin would affect the other in unpredictable ways.
Without experts in all of these fields who were used to dealing with unusual situations, it would not have been possible to safely separate the twins.
Another great advantage we had as a team was that a number of us had been involved in a similar separation a few years before. At the time, we had been advised and guided by two New York Surgeons, Jim Goodrich and David Staffenberg who had really established the principle of staged separation.
The separation would not have been possible without charitable funding. Facing the World, a London based charity raised the funds and organised the transfer of the twins to the UK. You can read more about the separation and other cases on their website www.facingtheworld.net
It has been an extraordinary experience leading the team that separated the twins which leaves me very proud to be part of Great Ormond Street Hospital and Facing the World.