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First ever reported surgical separation of Pygopagus twin boys in India to be attempted by Apollo Specialty Hospital, Vanagaram, Chennai

Date: 13 Dec 2013

Entire nation along with the mother of nine month old Ericana and Eludi from Tanzania will pray for their survival and speedy recovery

Pygopagus twins account for 17 percent of conjoint twin population in the world. Most common in females, only four cases of successful separation in males have been reported in medical history.

A defining moment in the lives of nine month old Ericana and Eludi, who have been joined at the tail end of their spines and sharing a single anus and rectum this surgery, if it succeeds, could possibly promise normal lives as two separate individuals.

Conjoined twins, though rarely encountered, are seen in one in 200,000 deliveries. However, more than 60% of them are stillborn while 35% of the remaining dies within a few days or months of birth due to various causes. Conjoined twins can be joined at the chest, abdomen, back, buttock and head. Fusion at the buttocks (Pygopagus) is very rare and accounts for less than 17% of all conjoined twins.

Live born Pygopagus twins are usually female in sex while male pygopagus twins are extremely rare. Till now in medical literature only 30 sets of Pygopagus twins have been reported out of which 26 were female and only four were male.

From Kasumulu to Vanagaram- the story of Ericana & Eludi:

In June 2013, a young mother from a small village called 'Kasumulu' in Tanzania came to Apollo Children's Hospital in Chennai with her 5 month old conjoint twin boys.

Nine months ago when she went for delivery to the dispensary in her village she was shifted to the District Hospital to undergo a cesarean section. But to the doctors surprise there was enormous difficulty in delivering the babies out of the uterus as they were joined at the back. The mother was told that separation of the babies was fraught with risk and she was sent to the Mohimbili Hospital in the capital Dar es Salaam by ambulance. It took three days to make this journey with the new-borns. At Mohimbili the doctors contacted the health officials for advice regarding further action.

Apollo Hospitals Chennai is closely associated with the Tanzanian government by the Save a Childs Heart Initiative (SACHI). The babies were therefore shifted to Apollo Children's Hospital in Chennai at four and a half months of age. After extensive work up it was found that the babies were joined at the tail end of the spines and shared a single anus and rectum. They were also found to have a single phallus and urinary passage.

"This set of male pygopagus twins for which separation is being attempted at Apollo Hospitals Chennai is the first in India. A unique and challenging aspect of the separation is the fused phallus, which has to be delicately separated to give each baby a functional penis. However, the separation of these babies is a mammoth task, which will take around 14 - 16 hours. Given the complexities involved, a chosen team of 20 doctors from the specialties of neurosurgery, plastic surgery, paediatric surgery and paediatric urology will attempt the separation." said Dr Venkat Sripathi, Senior Consultant paediatric Urologist, Apollo Children's Hospital, who is leading the much anticipated surgery.

Dr. Edward Kiely - Pediatric Surgeon from Great Ormond Street Hospital in London has been invited to proctor the operation while Dr. Richard Howard - Anesthetist, also from Great Ormond Street Hospital will be there as an observer.

Commenting on the case, Dr Roshini Gopinathan, Paediatric Plastic Surgeon, Apollo Children's Hospital said, "The babies are now 9 months old and weigh 16 kgs. During the last five months tissue expanders have been placed in the back, buttocks and thighs so that skin flaps can be rotated to cover the large defects, which will be left after separation. However, we are positive that the separation of these babies fondly called 'Ammukutty' and 'Chellakutty' by the nurses in the Hospital will proceed uneventfully."

Apollo Specialty Hospital in Vanagaram is preparing itself for what could make history in the Indian medical fraternity. Sharing her excitement on Apollo attempting yet another medical marvel, Suneeta Reddy, Joint Managing Director, Apollo Hospitals, said "The family has been with us for close to five months now and are very dear to us. In fact the babies have even learnt to say Thatha' and 'Athai' and the mother has picked up a smattering of Tamil as well. We are glad that The Tanzanian government has generously funded part of the treatment while Apollo Hospitals has subsidized the remainder of the cost involved in the separation and after care. We are hopeful about a positive outcome under the care and expertise of our highly skilled surgeons who have been handpicked to operate on them."

 
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