KNH prepares to separate another pair of conjoined twins

CEO Evanson Kamuri said the twins, admitted late last year, are being allowed to grow before surgeons attempt separation.

When a decision is made to separate conjoined twins, the surgery is usually done between six to 12 months after birth to also allow time for planning and preparation.

“We wait first until they have enough size. Sometimes we wait for one year to two years depending on which part of the body they are joined in,” he told journalists.

Dr Kamuri said the famous twins – Blessing Kathure and Favour Karimi – who were separated at the KNH in 2017, had waited two years before the surgery was done.

The hospital's consultant paediatric surgeon Dr Joel Lessan said when they receive such twins, first, they need to understand which body parts are fused and make a decision whether they are for separation or not.

“Because if they are sharing, for example, one heart, you cannot divide that into two, they'll stay like that. But if you find that there are structures that can be separated and live independently, that is when you plan for the separation. And then you've got to wait for the best possible time,” he said.

Dr Lessan heads  the KNH department of specialised paediatric care.

“When they are born usually at the weight of two or three kilos, the total blood volume might be 200 millilitres, just like a bottle of soda. So are we going to do the operation on a child who has a bottle of soda water blood volume?" he said. 

"So you let them grow, you feed them. Make sure they don't have infections. They grow, they're healthy, then you can subject them to the very intense and prolonged surgery.”

Dr Kamuri said that before the surgery medics create  3D dummies, and simulate the operation.

“We operate on those dummies until we are sure that when we go to the actual patient we will actually do something. We practice so many times until we perfect because we don't take chances with the human body,” he said.

On Monday, the medics reported they had successfully separated a pair of conjoined boys from Bungoma in a 15-hour surgery that began Saturday 10pm and ended midday on Sunday.

The four-month-old twins were conjoined at the chest and abdomen and were under observation since last September.

Dr Lessan, who led the 38 surgeons, said the twins shared a liver and had two hearts in one cavity.

Conjoined twins are a result of incompletely separated embryo cells. They multiply and differentiate to form different body organs and tissues.

The exact cause of such a situation is unknown but it’s thought that genetic factors interacting with environmental ones may contribute. Another possibility is the medication taken by the mother during pregnancy.

Dr Lessan said they had planned to separate the Bungoma twins when they reach six months of age.

However, one of the twins developed high pressure in the lungs, exposing them even greater danger, including imminent heart failure.

“This informed our team, even at four months, to start plans for separation. The challenge at this level was how to cover the defects left behind on their line of separation,” Dr Lessan said.

“We made an emergency decision to separate the twins because subsequent cardiac arrest would put the lives of the other twin in danger, therefore, we mobilised the team, equipment and medication culminating in the successful surgery.”

Both infants are still at KNH’s intensive care unit.