1 / 3

Conjoined Twins Surgery In India - Dr. Prashant Jain

Perplexed by this rare condition, the doctors in Nigeria told the parents that surgical separation of the twins was possible but they would have to lose one of the two girls. Then fate intervened and they were referred to Dr Prashant Jain, Head Pediatric Surgery Department BLK Super Specialty Hospital.

Dr385
Download Presentation

Conjoined Twins Surgery In India - Dr. Prashant Jain

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Conjoined Twins Surgery In India - Dr.PrashantJain ConjoinedTwins SurgeryIn India On21stApril, 2013,asuper specialityteam ledbyDr Prashant Jainat BLKSuperSpecialtyHospitalmadea decisiontosave twoprecariouslyhanging newbornlives. Bythenightof 12th August,2013 theyhadmadehistory. Thestorybehindtherarest ofrareseparationofconjoinedtwins at BLKSuperSpecialtyHospital. TwingirlsHussainaandHassanawerebornconjoinedinNigeria on28 August,2012.Celebrationsinthefamilysoonturnedtoshockandsorrow, however.Thetwinswerejoinedbackto back(pygopagusinmedicalterms). Toanextentthattheyhadcommon urinaryandvaginalopeninganda common anus. Aclantravelsacrosscontinentsinsearchof hope Perplexedbythisrarecondition,thedoctorsinNigeriatoldtheparentsthat surgicalseparationofthetwinswaspossiblebuttheywouldhavetoloseone ofthetwogirls.ThenfateintervenedandtheywerereferredtoDrPrashant Jain,HeadPediatricSurgeryDepartment BLKSuperSpecialtyHospital. Amultidisciplinaryteamofsuper specialists

  2. Amultidisciplinaryteamofspecialistsandsuperspecialistswasformed,led byaPediatricsurgeonDr.PrashantJain.Theteamconsistedofsuper specialistsfrompediatriccriticalcare,anesthesiology,neurology, neurosurgery,plasticsurgery,spinesurgery,neuro-anesthesia,vascular surgery, hematology,radiologyandtransfusionmedicine. State-of-the-arttechnologyatBLK CTangiography,MRIandMCUstudieswereconductedtoinvestigateand definethecomplexstructuralanatomyofthetwinsthroughhighdefinition images. MRIandCTScanrevealedthat girlshada commonsacralbone,they sharedtheirlowerspinalcords,lowergastrointestinaltractand genitourinarytracts.Theyalsohadacommonopeningforpassingstooland urine, andalsocommongenitalia.Fortunately,brain,heart,lungsand kidneysofeachtwinwerenormal.Thetwinstestedpositiveforasicklecell trait,andhereditaryblooddisorderthatincreasestherisksandcomplexity ofanesthesiaofanesthesiaandsurgeryfurther. Logisticsandplanning Aftermuchbrainstorming,theteamdecidedtoplanforseparationinthree stages.Inthefirststage,tissueexpanderswillbeplacedto getadequateskin for coveringtherawareasafterseparation.Inthesecondstage,actual separationofthespinalcords,intestineandgenito-urinarytractwouldbe carriedoutalongwithreconstruction.Insamestage,atemporaryopening (colostomy)forpassageofstoolwouldbemade ontheabdominalwall.In the thirdstage,colostomywouldbeclosedafter6weeks.Theteammet regularlyduringthenexttwomonthstoputthesurgicalplaninplace. Flowchartsdetailingthemovesofeachandeverypersoninvolvedinthe surgeryweremeticulouslypreparedandrefined.Everysurgicalstepwas definedandrehearsedoverandoveragaintillitreachedprecision.Thegirls werecolorcoded(onepinkandtheotherblue)sothattherewouldbe no error atall.Thiscolorcodewasextendedtoallcatheters,wires,tubesand leadsthatwouldbeconnectedtothegirlsduringsurgery.Theteamdecided touseanadvancedtechnique ofneuro-monitoringto avoidanydamageto thenerverootsofbothspinalcords.Theanesthesiologist’sjobwasmadeall themorechallengingbythefactthatwhateverdrugwasgivento onetwin, theotherwouldreceiveitinadvertentlythrougha largesharingvein,and dosages werecalculatedandmonitoredaccordingly.Surgicalstepswere

  3. practicedusingdummiesprocuredforthepurpose.Reconstructionofhigh definition imagesshowedthatthetwinshadasharedbloodcirculation, therebyextendingacluetotheanesthesiologiststoplanformanagingthe riskofpassingofdrugsfromonechildtoanotherduringsurgery.Eachtwin wasassignedaseparateteamofdoctorsrepresentingeachspecialty,someof whomwerenotparticipateinthesurgerybutwouldbe onstandbyif anything wentwrong. May25,step1 Tissueexpanderswereplacedon25thMay.Theseareessentiallysiliconbags, whichwereplacedundertheskinonthebuttocks.Theseweregradually inflatedoncea weekbypumpinginsalineoveraperiodof2month. This helpedinexpansionoftheskin andgenerationofgoodtissuecoverrequired during thesurgery. August12, step2(AfterseparationinICU) Thesurgerybeganat6AMonAugust12th,2013.Relayteamsofsurgeons whoweretaskedwithseparatingthethreeinvolvedsystemswithoutany compromise,movedinandoutoftheOTinaccordancewiththeflowcharts preparedearlier.Neurosurgeonsusedmicroscopes,whileseparatingthespinal cords.Intensiveneuro-monitoringwasconductedduringtheentiresurgery. Thegirlswerere-positionedtwiceduringthesurgeryto enablesurgeonsto gainaccessto areasthatwereto be separated.After13nerve-wracking hourslater,thegirlsweremovedtoseparateoperationtheatresforfurther reconstructionofgenitalia,urethraandanusbyPediatricsurgeon. Therecovery Afterthesurgery,thegirlswereshiftedtothePediatricICUwherethey wereelectivelykeptonventilatorsupportfor24hrswithclosemonitoring ofbloodpressure,bloodoxygenandcarbondioxidelevels,bodytemperature andurineoutput.Theyweregraduallytakenoffartificialventilationthenext day.Presently,bothtwinsarestableandhaveshownno signsofany neurologicaldeficit.

More Related