Performing one of the rarest surgeries, a team of doctors at Post Graduate Institute of Medical Education and Research (PGIMER) successfully separated two conjoined sisters — Jannat and Mannat — on November 23. According to Dr Ravi Kanojia, associate professor, department of paediatric surgery, “Chances of such births are one in five lakh. This is a rare case scenario and a surgeon would be fortunate enough to see a couple of cases in his or her lifetime.”
He said it was for the first time that such a surgery had been successful at the PGIMER. Children did not survive in similar surgeries performed earlier about 10 years ago, the doctor said.
Born on August 27 in Barara town of Ambala, Jannat and Mannat were rushed to PGIMER within a week after birth. “Jannat and Mannat were brought to us soon they were born as conjoined twins at a private hospital. They were joined at their abdomen and lower part of chest — a condition known as omphalophagus twins in medical term. The sisters together weighed only 3kg and were very fragile,” said Dr Kanojia, the surgeon who led the team.
The team of doctors evaluated the risk in sugery and the survival chances. “We called the family three or four times for conducting tests such as CT and MRI scan to find out the organs the sisters shared. We found that the twins had a conjoined liver in between, fortunately rest of their organs were separate,” said the doctor.
The doctor said that worldwide, separation surgeries on conjoined twins are generally performed when the children become one year old or more. “But in this case, we performed the surgery while the babies are only three-month-old, weighing only 4.2 kilos. We concluded that delay could hinder their growth,” he said.
The doctor said the case was extensively planned between paediatric surgery team, anaesthesia team, paediatric ICU and the radiologist. “A 30-member-team was formed which was divided into two surgical units. There were two surgical teams, two anaesthesia teams and two post-operative care teams for the procedure. Two operating theatres were prepared for the procedure,” said the surgeon.
Entire unit was led by Dr Ravi Kanojia, assisted by paediatrics surgeon Dr Jai Kumar Mahajan.
“On Sunday, a day before the surgery, pre-operation meeting was held and a mock-drill was attended by the entire team,” said Dr Kanojia.
The surgery was done on November 23 and the 30-member team slogged for eight hours to separate the twins.
“While Jannnat did well from the beginning, Mannat being smaller of the two had to be kept on ventilator for some time. She has eventually recovered well and both girls are now recovering fast and are ready to go home soon,” said Dr Kanojia.
On the complexity of such surgeries, Dr Kanojia said, “The complexity of such surgeries varies from case to case. It depends on the number of organs shared by the twins, if there are many organs then it becomes more difficult and surgeons may have to choose survival of one of the two babies.”
“In this particular case, the challenge was to divide the liver carefully without dividing the blood supply going to the twins. Maintaining anaesthesia was also a challenge,” said the doctor.
As the parents of the babies came from a financially poor background, the hospital administration helped in arranging the surgical consumables free of cost.
The news of the birth of two daughters did not saddened Mohammad Saleem, who was already a father of two daughters – Nargis and Nagma — when the conjoined twins took birth. But Jannat and Mannat’s medical condition came as a setback to him. A labourer from Barara, Ambala, Saleem could not afford the treatment, but he did not lose hope and visited two private hospitals before moving to PGIMER.
“People used to say that they will not survive and PGIMER was my last hope. Nobody in the world could have attended my daughters better than the doctors did here. They are God to me and will worship them,” said Saleem, who is now preparing for the celebrations.