Abstract
Introduction
We describe our experience with 22 conjoined twins managed from 1974 to 2006.
Materials and Methods
Records of 22 conjoined twins admitted from 1974 to 2006 were reviewed. Interviews with attending physicians were also conducted.
Results
There were 11 thoracopagus, 5 omphalopagus, 3 ischiopagus, 2 craniopagus, and 1 pygopagus twins. Five thoracopagus twins were deemed inseparable due to severe cardiac anomalies. One ischiopagus refused separation, and one craniopagus was separated elsewhere. Six twins (three omphalopagus, one each of pygopagus, ischiopagus, and thoracopagus) were separated emergently as neonates; only one twin is a long-term survivor. Mortalities were due to intractable acidosis, sepsis, and hemorrhage. Nine twins (one craniopagus, one ischiopagus, two omphalopagus, five thoracopagus) were electively separated between 9 months and 2 years of age. One set of these thoracopagus twins died of respiratory failure and sepsis post-operatively. A hydrocephalic twin in another thoracopagus twin died intraoperatively. The rest are alive and well.
Conclusions
Emergency separations yielded dismal results due to poor patient conditions; delay in separation allowed progressive deterioration and resultant poor outcome. Elective separation had more favorable results due to well-planned strategies, team preparedness, and better patient conditions. A multi-disciplinary approach, with parental participation, is integral in the holistic management of conjoined twins.
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References
O’Neill JA Jr, Holcomb GW III, Schnaufer L et al (1988) Surgical experience with thirteen conjoined twins. Ann Surg 208:299–312
Spitz L, Kiely EM (2002) Experience in the management of conjoint twins. Br J Surg 89(9):1188–1192
Poenaru D, Uroz-Tristan J, Leclerc S et al (1994) Minimally conjoined twins: a consistent spectrum of anomalies. J Pediatr Surg 29:1236–1238
Carnevale CC, Borges MV, Affonso BB et al (2006) Importance of angiographic study in preoperative planning of conjoined twins: case report. Clinics 61(2):167–170
Andrews RE, MacMahon CJ, Yates RWM et al (2006) Echocardiographic assessment of conjoined twins. Heart 92:382–387
Fishman S, Puder M (2002) Cardiac relocation and chest wall reconstruction after separation of thoracopagus conjoined twins with single heart. J Pediatr Surg 37:515–517
Spitz L, Kiely E (2003) Conjoined twins. JAMA 289:1307–1310
Satherge M, Venkannagari R, Clauss R (1998) Scintigraphic evaluation of craniopagus twins. Br J Radiol 71:1096–1099
Chen W, Lai HS, Chu SH et al (1994) Separation of ischiopagus tripus conjoined twins. J Pediatr Surg 29:1417–1420
Spencer R (1996) Minimally united ischiopagus twins: infraumbilical union with cloacal anomalies. J Pediatr Surg 31:1538–1545
Spitz L, Kiely EM (2002) Experience in the management of conjoint twins. Br J Surg 89(9):1188–1192
Spencer R (1996) Anatomic description of conjoined twins: a plea for standardized terminology. J Pediatr Surg 27:941–944
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I certify that all my affiliations with or without financial involvement in, within the past 5 years and foreseeable future, any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript are completely disclosed (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, royalties).
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Saguil, E., Almonte, J., Baltazar, W. et al. Conjoined twins in the Philippines: experience of a single institution. Pediatr Surg Int 25, 775–780 (2009). https://doi.org/10.1007/s00383-009-2426-7
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DOI: https://doi.org/10.1007/s00383-009-2426-7