Conjoined Twins Die After Separation Surgery

[GMUBunny]

This is so sad:

SINGAPORE (July 8) - Iranian twins Laleh and Ladan Bijani, joined at the head for 29 years, died within 90 minutes of each other Tuesday after doctors separated them but were unable to control their bleeding in the unprecedented surgery.

In their homeland, people cried out in shock or wept as state television broke into normal programming to announce their deaths during the third day of surgery in Singapore.

``Is my beloved Ladan really not with us anymore?'' Zari Bijani, an elder sister of the twins, said after Ladan's death was reported. Seconds later, she fainted.

Hospital officials said Ladan died 90 minutes ahead of her sister Laleh, with both deaths because of blood loss. They died while still under anesthesia.

``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.''

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 twins had gone into the surgery saying they knew the risks but wanted to achieve their dream of living independent lives - Laden wanted to continue as a lawyer, Laleh wanted to switch to become a journalist. Speaking in English to journalists last month, their joined heads wrapped in a single scarf, the smiling and laughing sisters said they wanted for the first to look at each other face-to-face.

``We have different ideas about our lives,'' Laleh said. ``Actually, we are opposites,'' Ladan interrupted, laughing.

``If God wants us to live the rest of our lives as two separate, independent individuals, we will,'' Ladan said before the final tests Saturday ahead of the surgery.

The risky, marathon separation procedure began about 10 p.m. EDT Saturday. Before the operation, doctors warned that the surgery could kill one or both of the twins, or leave them brain-dead.

``When we undertook this challenge, we knew the risks were great. But we were hopeful. Ladan and Laleh knew the risks too,'' said Dr. Loo Choon Yong, chairman of Raffles Hospital. ``As doctors there is only so much we can do as the rest we have to leave it to the Almighty.''

From the start, doctors ran into unexpected obstacles not found in the infants that the operation has until now been performed on. It took longer to cut through portions of the sisters' skulls because their older bones were denser than previously believed.

And though the Ladan and Laleh's brains were separate, they had adhered to each other after years of growing and sharing the same space. That forced doctors to meticulously cut the organs apart, ``millimeter by millimeter,'' Raffles hospital spokesman Dr. Prem Kumar said.

``As the separation was coming to a close, a lot of blood was lost. The twins were subsequently in a critical state,'' said Kumar.

Working in two groups, surgeons gave each twin blood transfusions, but in the end they were unable to cope with the unusual blood flow patterns, he said.

``I was concentrating very hard on Laleh at the time,'' lead neurosurgeon Dr. Keith Goh said, recounting the moment when he knew the operation had gone wrong. ``I was very saddened when I looked over and saw them struggling, of course at the same time, we were struggling too.''

A crucial part of the surgery had been to deal with a finger-thick vein shared by the sisters that drained blood from the brain. In 1996, German doctors had told the twins that shared vein made surgery too dangerous.

During the operation, the surgeons grafted a similar sized vein from Ladan's right thigh to her brain, then rerouted the shared brain to her sister.

But Ladan's new vein became congested, and surgeons Monday night considered wheter to call off the rest of the operation and leave the twins joined or ``continue with final stage of the surgery, which we knew would be very, very risky,'' Loo said.

``The team wanted to know once again what were the wishes of Ladan and Laleh,'' Loo said. ``We were told that Ladan and Laleh's wishes were to be separated under all circumstances.''

For more than 50 hours, the team of 28 doctors and about 100 medical assistants worked in tight spaces in front of and behind the twins, who were in a sitting position in a custom-built brace connected to IVs and monitors. Classical music played softly, and surgeons whose expertise was not needed at the moment would slip out of the room for rest.

In the final hours, the surgeons 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.

``I am very sad, as all of us are,'' Goh said. ``Over the last six months, everyone who came in contact with them was touched by their personalities and the kind of people they were.''

The courage of the twins won them a place in the hearts of Iranians. Television devoted many programs to the twins. Newspapers published page after page about their life and the protracted operation.

Parents of the twins, Dadollah Bijani and Maryam Safari, thanked the Iranian nation for praying for their children, the state-run Tehran radio reported.

``It's a national tragedy,'' said Ahmad Mahmoudi, a photographer in Tehran.

Housewife Noushin Nowrouzi promptly parked her car after she heard the news on the radio so she could cry in peace.

The sisters were born into a poor family of 11 children in Firouzabad, southern Iran, but grew up in Tehran under doctors' care.

The Iranian government said Monday it would pay the nearly $300,000 cost of the operation and care for the twins.

Participating neurosurgeon Dr. Benjamin Carson, director of pediatric neurosurgery at Johns Hopkins Children's Center in Baltimore, has separated three sets of craniopagus twins.

07/08/03 11:13 EDT

[CutiePie2000]

It is sad. I heard on the radio yesterday, that their odds were 50-50 which is really not that encouraging.

[NinjaPoodle]

[PM_Mama00]

That is so unbelievably sad that something they wanted so bad caused them their life.

[cash78mere]

i read about them the other day and was excited for them. this is so sad

[CatStarESP4]

This is very devastating! I was hoping they both survive this controversial and dangerous operation.

[Peaches-n-Cream]

This is so sad. I had hoped that the surgery would be a success when I first heard about it. They really wanted to live separate lives. What a tragedy.

[LeslieAGD]

After being together for so long, perhaps hearing of her sister's death probably, in part, caused the other sister's death.

[CutiePie2000]

Originally posted by LeslieAGD
After being together for so long, perhaps hearing of her sister's death probably, in part, caused the other sister's death.

I would think that they were both unconscious during the 50+ hour surgery??

[LeslieAGD]

Originally posted by CutiePie2000
I would think that they were both unconscious during the 50+ hour surgery??

Sorry, I read this line, "Is my beloved Ladan really not with us anymore?'' Zari Bijani, an elder sister of the twins, said after Ladan's death was reported. Seconds later, she fainted" and disregarded that it was another sister...I thought it meant that one of the twins knew the other had died.

[aephi alum]

It's a highly risky procedure, but I'd hoped that at least one of them, if not both, would survive.

[UKDaisy]

Originally posted by LeslieAGD
Sorry, I read this line, "Is my beloved Ladan really not with us anymore?'' Zari Bijani, an elder sister of the twins, said after Ladan's death was reported. Seconds later, she fainted" and disregarded that it was another sister...I thought it meant that one of the twins knew the other had died.

That is so sad!!!!!!! I can't believe I was just watching them on TV and now they are gone. I was really hoping they would survive.

[honeychile]

How terribly sad, both for the women involved, and for their family.

Was any reason given as to why the operation wasn't tried while they were still infants? I have to admit, if they were my babies, I'd take the risk, too.

[Rudey]

Originally posted by honeychile
How terribly sad, both for the women involved, and for their family.

Was any reason given as to why the operation wasn't tried while they were still infants? I have to admit, if they were my babies, I'd take the risk, too.

When they were young, their father took them to a lot of doctors. Many of the doctors said they'd be unable to do the surgery. I think at that time the technology was not advanced enough to. Their father (adopted) also met with Ayatollah Khomeini in France and the Ayatollah said it would not be permitted to go against G-d and perform the surgery.

Advance many years until now. The doctors made many technological and surgical improvements and thought they'd be able to offer a 50/50 survival rate for seperating the twins. The father was against it but it was the twins that wanted it so bad. They spent many months getting tested physically and psychologically before being accepted for the surgery.

-Rudey
--It is really, really sad.

[SATX*APhi]

I heard about this yesterday. It is terribly sad. Their wishes were to be separated, no matter the risks. I admire their courage. God bless them and their family.