With a number of risky surgical separations capturing public attention recently, doctors at Johns Hopkins Hospital said yesterday that the separation last week of 2-month-old Nigerian sisters Faithful and Favour could not have been simpler.
Sitting alongside colleagues and the twins' parents at a news conference yesterday, pediatric surgeon Dr. Paul Colombani said the girls were fortunate not to share any vital organs except their liver, the only organ that regenerates when divided.
"They are basically healthy children right now," Colombani said, adding that the natural growth of tissue across the 4-inch patch where they were attached should erase any appearance of an abnormality.
The girls also benefited from the fact that they were divided so early in life, meaning that their skin and muscles were still elastic. Surgeons were able to close the incisions by stretching and fashioning tissue flaps from surrounding tissue - without resorting to tissue grafts or artificial materials.
Faithful and Favour are expected to remain in Baltimore for a few weeks before they are cleared to return home with their parents.
Lasting a scant two hours, the operation went so smoothly that the girls didn't need any transfused blood.
"I am very happy for them to live their separate lives," said the girls' father, Abayomi Sobowale-Davies, who sat alongside his wife, Kikelomo. "This is not an easy thing for the mother and father themselves to face. But they are doing good.
"We say thank you very much and God's blessings on all your endeavors," he said to several doctors and nurses who were seated nearby. In all, 17 specialists - including surgeons, anesthesiologists, nurses and technicians - took part in the operation. Directing the surgery were Colombani and Dr. Henry Lau.
Already the parents of two daughters, the Sobawale-Davies knew their lives would become complicated as the delivery of their twins drew near. But, lacking prenatal images of the girls, they didn't know how complicated until surgeons in a Lagos hospital performed a Caesarean section and discovered that Faithful and Favour were fused.
Not long after the girls were born, a Washington doctor of Nigerian descent, traveling in Lagos, heard of the case and stepped in to help. The doctor, Sikuru A. Tinubu, contacted officials at Hopkins and interested them in taking on the case.
Colombani, who is director of pediatric surgery there, said doctors donated their services while the Children's Center covered the $20,000 to $25,000 in hospital expenses by drawing from private donations.
Surgery to separate the twins' chest bone, abdominal wall and liver took about an hour. Then, the medical team broke into two units, one for each twin, to close the incisions. For this second phase, which took another hour, personnel assigned to Faithful wheeled her into an operating room across the hall and worked on her there.
To avoid any confusion, yellow or red labels were affixed to all equipment and personnel - yellow for Favour, red for Faithful.
Though conjoined twins are a rarity, the Hopkins operation came amid a spate of publicity over other cases. In July, surgeons working in Singapore separated 29-year-old Iranian sisters joined at the head, but the women bled to death.
Elsewhere, medical teams in New York and Dallas are planning operations to separate two sets of twins who are also joined at the head. And on the same day Faithful and Favour were divided, surgeons in Los Angeles separated twin girls who were joined from stomach to hip.
Modern surgical techniques along with high-tech imaging are enabling doctors to attempt operations that they might not have considered in the past, Colombani said. CT scans produce three-dimensional images that enable doctors to examine the bodies from every angle and plan their moves.