Marathon op starts to separate conjoined twins

A pair of 29-year-old Iranian twin sisters who are joined at the head began a marathon operation today that could finally separate them – or kill them.

After a lifetime of compromises on everything from when to wake up each day to what career to pursue, Ladan and Laleh Bijani said they preferred to face the dangers of the surgery – which could last up to four days – rather than continue living joined together.

“If God wants us to live the rest of our lives as two separate, independent individuals, we will,” Ladan said on Saturday.

The twins had said they wanted to walk into the operating room at Singapore’s Raffles Hospital as a sign of courage, but they were brought in by wheelchair because they were too tired to stand, hospital spokesman Dr. Prem Kumar told reporters.

An international team of 28 doctors and about 100 medical assistants will participate in the surgery, which will last at least 48 hours and could take four days.

“It’s going to be a good day,” the lead neurosurgeon, Dr. Keith Goh, said as he arrived at the hospital today. He said he and his wife spent the morning praying for the twins.

The Bijani sisters have tried for years to persuade doctors to separate them, even though the operation could kill them.

“For almost as long as they can remember, they’ve been looking forward to this – hoping it will happen,” said Bahar Niko, a Singapore-based Iranian who became a friend of the twins after they arrived in Singapore in November.

Niko was one of seven friends who joked, laughed and prayed with the twins just before they were wheeled in for surgery.

The sisters, born in Firouzabad, southern Iran, in 1974, have separate brains that lie next to each other in a joined skull. Their heads are connected but their bodies are otherwise distinct.

It is the first time that surgeons have tried to separate siblings born joined at the head since the procedure was first successfully performed in 1952.

Previously, the surgery has only been performed on infants whose personalities aren’t formed and brain tissue is more adaptable to changes.

The surgeons’ most daunting challenge will be dealing with a single shared vein that drains blood from the women’s brains. German doctors told the twins in 1996 that the vein made surgery too dangerous.

Vascular surgeons began removing a vein from one of the twin’s legs so the neurosurgeons could use it in place of the shared vein, Kumar said.

Before the operation, doctors conducted four hours of last-minute tests on the sisters to study how blood flows through their brains.

The tests revealed a new medical reason for the surgery to proceed, Goh said.

The pressure inside the twins’ brains was more than twice what it should be.

The discovery led doctors “to believe this is something quite necessary, not cosmetic or frivolous,” Goh said.

Dr. Benjamin Carson, another lead surgeon and director of paediatric neurosurgery at Johns Hopkins Children’s Center in Baltimore, Maryland, estimated that the sisters each have a 50-50 chance of survival.

“We’ve spent the past couple of days going through all the possible ramifications, recognising that we still may in fact find some surprises,” Carson told reporters on the eve of the surgery.

The 288,000 dollar (£200,000) cost of the surgery is being underwritten by Raffles Hospital, and the doctors’ fees are being waived.

The sisters came to Singapore after hearing about Goh’s success in separating 18-month-old Nepalese infants who were also joined at the head.

Singapore’s government has been promoting the Southeast Asian country as a regional hub for medical services. Leaders hope to boost the country’s flagging economy by lessening its long-time dependence on high-tech manufacturing – a field in which it faces growing competition from other Asian countries, especially China.

Both sisters studied law because Ladan wanted to be a lawyer. But after the surgery, Laleh wants to move to Tehran to be a journalist, while Ladan wants to move back home with her parents and continue her law studies.