A team from Mulago hospital that successfully separated the Siamese (conjoined) twins has addressed some queries and given more details about the 20 hour surgery.
The twins were born in December 2019 to Mr Bonny Otuka and Ms Brenda Ajok in Lira Regional Referral Hospital after an urgent referral from a health centre due to the difficulty encountered in the early stages of labour.
Ajok later delivered by caesarean section and was thereafter referred to Mulago Hospital together with her babies.
Dr Rosemary Byanyima, the Deputy Executive Director of Mulago said that the twins had to be prepared for surgery and but with the unforeseen lockdown effected in March, they were allowed to go home at their request.
In June 2020, however, the family registered difficulties in feeding the babies who were 7 months old then and were getting malnourished as the mother’s breast milk couldn’t sustain the two of them.
“Arrangements were made to bring them back for admission and they were received by a team of health experts who prepared the babies and took care of the malnutrition issue,” she said.
According to Dr John Sekabira, the senior paediatric consultant at Mulago, the twins were sharing some body organs like a rectum and the vagina.
“They were sharing a common rectum but good enough, on the inside, the rectum was separate, but closely fused with the vagina. The urethra was distinctively shared by both of them,” Dr. Sekabira said.
He noted that the babies were in the theatre by 8 am on Monday and were being prepared for surgery. They were put to sleep and at midday the surgery started.
“It wasn’t a simple surgery because we wanted to go meticulously, slowly and we were working with teams. We had the paediatric surgery team to separate at the first stage followed by other teams like the neuro surgeons who separated the nerve structures, spinal cord and later on those who separated the blood vessels,” he said.
However, Sekabira said, there was still another task as the tube covering the spinal cord was opened during the surgery and the neuro surgeons had to find a way to cover it so that the nerves are protected.
Improvised excretion openings were also made since the rectum and urethra were being shared by the twins.
“We hope later on when they grow up, we shall be able to correct these abnormalities,” he said.
Dr Sekabira said that such abnormalities are not common in most countries and therefore they are hardly worked upon.
“Out of 200,000 live births, only 1 can have this condition. At Mulago, we get like 3 or 4 siamese twins annually. The survival depends on which organ they share. For instance if they share the brain, they usually don’t survive the surgery. If you are not careful during surgery, they can bleed to death,” he said.
He said that most surgeries like this are hindered by the fact that by the time they are referred to Mulago, the twins are already infected including the lungs and usually, they don’t survive.
Although the surgery was done at a free cost, Dr Sekabira said that the operation would cost a lot of money especially in developed countries.
David Niwamanya, the hospital administrator said, “For now, we are doing a test run. So, we are not charging for the services.”
Sekabira said that after 6 months to 1 year, the twins will undergo another surgery as the tissues will have healed through the inflammatory phase and they will be able to properly place the reproductive systems and rectums where they are meant to be and probably create the urethra.
For now, the doctors said, the babies will stay at Mulago where they will be monitored.
Dr Byanyima urged pregnant mothers to attend antenatal care services for such cases to be detected early and prepared for.
“They should attend antenatal and at least have 2 or 3 antenatal ultra sound scans so that such abnormalities are picked and then they are referred to appropriate care.”