Conjoined twins die after being separated

“IS my beloved Ladan really not with us anymore?” Zari Bijani, an elder sister of a conjoined twin, said after Ladan’s death was reported.

Seconds later, she fainted.

A few hours later a Singapore hospital announced Laden's siamese sister Laleh had also died.

The 29-year-old conjoined twins from Iran died yesterday shortly after neurosurgeons separated them in the third day of surgery.

"Everyone upstairs is crying," said the nurse, speaking on condition of anonymity.

"We treated them like family because they had been here for seven months."

Earlier, doctors said Ladan died after they were unable to stabilise her condition.

"As the separation was coming to a close, a lot of blood was lost. The twins were subsequently in a critical state," said Raffles hospital spokesman Dr Prem Kumar.

The risky marathon separation procedure began on Sunday morning.

Before the operation, doctors warned that the surgery could kill one or both of the twins, or leave them brain-dead.

It was the first time surgeons tried to separate adult craniopagus twins siblings born joined at the head.

The surgery has been performed successfully since 1952 on infants, whose brains can more easily recover.

The brains of Ladan and Laleh Bijani were separate, but were nonetheless stuck together after years of lying alongside each other.

Kumar had warned that controlling the bleeding and moving the twins from a seated position onto separate beds would be the biggest challenge, and that the condition of either twin would remain largely unknown until they wake up after surgery.

The twins were seated during the operation.

As one of the final points of the separation procedure, surgeons cut a finger-thick shared vein from Ladan leaving her to rely on a similar sized vein taken from her right thigh that was grafted to her brain.

Rerouting the finger-thick shared vein, which drained blood to their hearts, was considered one of the biggest obstacles in the surgery.

German doctors told the twins in 1996 that shared vein made surgery too dangerous.

The team of doctors had to contend with unstable pressure levels inside the twins' brains just before they worked to uncouple the sisters' brains and cut through the last bit of skull joining them, Kumar said.

The sisters' brains had "to be teased apart very slowly", Kumar said. "Cut. Teased apart. Cut. Teased apart. In the process, you encounter a lot of blood vessels and other tissues."

He said surgeon worked "millimetre by millimetre".

Dr Marc Mayberg, chairman of neurosurgery at the Cleveland Clinic in Ohio, had said by telephone the pressure fluctuations could be fatal.

Although the sisters knew the operation could kill one or both of them, they decided to face those dangers

after a lifetime of living conjoined and compromising on everything from when to wake up to what career to pursue.

"If God wants us to live the rest of our lives as two separate, independent individuals, we will," Ladan said before the operation.

An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery.