UM Medical Center team separates conjoined twins

Girls who were fused at heart, liver, diaphragm are thriving, doctors say

Intricate 12-hour operation

May 15, 2002|By Jonathan Bor | Jonathan Bor,SUN STAFF

An odyssey that began last fall with the delivery of conjoined twins in a hospital near the border of Uganda and Congo has ended happily with the separation of two healthy girls at the University of Maryland Medical Center.

The girls, Loice and Christine Onziga, sat wriggling and cooing in their parents' arms yesterday as surgeons described the intricacies of an operation that lasted 12 hours and involved 35 medical professionals.

"Today, my wife and I are very happy parents to see that both our daughters are alive and separate," said Gordon Onziga, who farms 6 acres in a village in Uganda.

Surgery on the twins - who were born attached from the breastbone to the navel and fused at the heart, liver and diaphragm - took place April 19 but was kept quiet until yesterday. Doctors said the 6 1/2 -month- old girls were thriving physically and emotionally; they seem happiest when placed in the same crib, where they can playfully paw at each other.

At a news conference yesterday, surgeons described the tense moment when they clamped a blood vessel that connected the sisters' hearts. It was then that doctors observed that the hearts could beat independently and would not require risky reconstructive surgery. Surgeons were able to complete the operation, confident that the sisters could survive apart.

"We expect them to live normal, healthy, productive lives as two individuals," said Dr. Eric Strauch, a pediatric surgeon who directed the operation with Dr. Marcelo Cardarelli.

Though the sisters still arch their backs slightly, a holdover from the days when they strained not to bump heads, doctors expect them to achieve a normal posture and eventually crawl and walk normally.

It could take another year or so for the sisters to catch up with other children their age, though doctors said they saw no reason why they would not develop normally on every level.

Doctors said yesterday that they expect to discharge the girls in several days to the nearby Ronald McDonald House, though they will probably remain in Baltimore for medical care until November.

The Onziga sisters' journey began in October when their mother, Margret, went into labor and prepared to deliver what she thought was a normal baby at her family's home in Congo, formerly Zaire. When she failed to progress, she was taken by bus to a hospital where two fused babies were delivered Oct. 28 by Caesarean section.

They were transferred to a regional hospital just across the border in Uganda and later to Mulago Hospital in the Ugandan capital, Kampala. There, the sisters came to the attention of doctors from the University of Maryland who were participating in an exchange program.

Because Uganda did not have facilities to perform the complex separation, the doctors worked through officials at the University of Maryland to have the twins flown to Baltimore for surgery. The sisters arrived Feb. 28.

On April 19 - in an operating room packed with surgeons, anesthesiologists, nurses, technicians, biomedical engineers and electricians - the girls were separated.

The operation was provided free to the family by the University of Maryland Medical System. Doctors said it would be months before they could tally the cost, which promises to run into the hundreds of thousands of dollars.

It was the second separation of conjoined twins at the University of Maryland and the fifth in Baltimore. Three have been performed at Johns Hopkins Hospital.

Conjoined twins occur about once in every 200,000 live births. The condition is actually more common than that, but most attached fetuses die in the womb. The condition occurs when identical twins fail to separate in the womb. The overall survival rate of conjoined twins is between 5 percent and 25 percent, with about 75 percent of surgical separations resulting in at least one twin surviving.

Though precise statistics aren't kept, some estimates place the number of surgical separations at about 200 worldwide, with most performed since 1950.

In this case, doctors at the Kampala hospital were reassured by results of a crude CT scan that a surgical separation could be successful. This was because each of the girls, though fused along the chest and abdomen, had a full complement of organs - though the connection between their hearts remained mysterious.

Dr. Cindy Howard, a UM pediatrician who visits the Kampala hospital two months a year, said she was intrigued when the hospital's pediatrics chief, Dr. Margaret Nakakeeto, told her about the unusual patients and asked for her help.

"She described them as gorgeous babies who seemed to have a chance," Howard recalled yesterday. "She said, `These children can do well, as well as we can guess. Can you think about it?'"

Though she made no promises, Howard called Dr. Jay Perman, chief of pediatrics at the University of Maryland Medical Center. Perman, along with hospital officials, eventually arranged to accept the twins there.

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