3 dimensional dummy, 27-hour surgery, multidisciplinary medical team and an army of healthcare professionals!

Presenting from Cameroon when they were 9 months old, the conjoined twins, Elizabeth and Mary, were discharged after they got healthy again following 7-month treatment in Turkiye!

Being born in July of last year in Cameroon, the Siamese twins Elizabeth and Mary were joined at the hip. They had shared numerous aspects of the body system along with physical body parts. Ranging from the spinal cord and a part of the spine to the urinary tract, digestive tract, urogenital systems and neurovascular structure… Following a tremendously comprehensive search, the conjoined twins were brought to Acıbadem Altunizade Hospital from Cameroon when they were 9 months old. Physicians of numerous departments, an army of healthcare professionals, numerous diagnoses made in 7 months and finally the surgery and postoperative treatment; now, these cute twins are living as two physically independent babies. The separation surgery that lasted for 27 hours was successful. Now, they are 16 months old and they are happy to have their own bodies before they are discharged.

Caroline and Richard Akwe, a couple married for 3 years living in Cameroon, were unbelievably eager to hug their twins. Caroline Akwe, 26, had pregnancy supervision visits regularly and everything was seemingly alright. When the calendar hit July 6th, 2020, the twins were given birth with Caesarean section on term, but with a much unexpected surprise! Twins were joined at their hips!… When the mother completely recovered from anesthesia, nurses were not pretty willing to meet the twins with their mother. They were experiencing hard times to answer the mother’s questions where words fail, only their eyes could not be hiding how confused they were. Feeling grateful that their babies were alive, the young parents were still standing sturdy. 

I had difficulty in breastfeeding as they were conjoined

28 years old father Richard Akwe says “Believing that they were getting hurt, as they could not be moving comfortable, we were terribly upset. Besides, we were feeling very sorry for their cry while my wife was trying to nurse them one by one when they were hungry, but they were our gifts and we, therefore, devoted ourselves for their best care”, while the mom Caroline Akwe adds “I nursed my conjoined babies for one year despite all challenges. We had never given up our hope that they would be separated in a healthy manner. And our dream has come true through extraordinary efforts and success of Turkish doctors”.

Twins bite off more than they can chew!

Cameroon was lacking the medical and technical means to separate the twins. While the Akwes were struggling with many challenges, the father, Richard Akwe, on top of it, was locked out in Covid-19 pandemic that had deeply influenced Cameroon, as is the case with the whole world. However, a hope had come out of the blue sky; Cameroon Presidency Office had undertaken treatment of the conjoined twins. Doctors of Acıbadem Hospital were contacted. All plans were made and cute Siamese twins were brought to Acıbadem Altunizade Hospital on March 30th, 2021 before the matchless surgery process has started. 

Mobilization was ordered!

Physicians of numerous departments, ranging from urology and intensive care unit to radiology, physical medicine and rehabilitation and cardiovascular surgery, and an army of healthcare professionals have campaigned under supervision of Professor of Pediatric Surgery Burak Tander, Professor of Pediatric Neurosurgery Memet Özek, Professor of Aesthetic, Plastic and Reconstructive Surgery Hakan Ağır, Associate Professor of Anesthesiology Serpil Ustalar and Professor of Pediatric Intensive Care Agop Çıtak – all from Acıbadem Altunizade Hospital – to separate the conjoined twins. The multidisciplinary treatment has lasted for 7 months.

Each detail is clarified on 3-dimensional dummies! 

The aim was to help both babies hold on to life. Three-dimensional dummies of the twins were created through preoperative radiological and angiographic examinations to help both of them gain their own bodies and to minimize the risk. Because the babies had both personal and joint complex problems. The three-dimensional dummy of the conjoined twins preoperatively created by Bio-design Center of Acıbadem University had made significant contribution to the success of the surgery, as physicians examined the dummy for numerous days. 

Left the operating theater with their own bodies following 27-hour surgery!

The twins had opened eyes to the morning of a very big and critical day, when the calendar hit August 12th, 2021. They were placed on the surgical table to separate their fused bodies. Starting at 08:00 a.m., the surgery has lasted for 27 hours. After such a critical surgery was successfully completed, Elizabeth and Mary were, for the first time in their life, lying on different beds at the intensive care unit on August 13th, 2021. They woke up into a totally new life! They had a conjoined 1st year birthday, but they were reborn when they were 13 months old! Since they were fused at their hips, they had never seen the face of each other. It was not a surprise to see them how confused with their separated bodies, but they gradually started enjoying the comfort of having an own body; their happiness was reflected by their shiny eyes and kittlish body language, as they need some time to express verbally what they actually feel. 

They looked for each other after being separated

Falling short of words to express the happiness they felt when they say their babies separated following a long and critical surgery and stating that they felt like at home in Acıbadem Altunizade Hospital, where they found the remedy they were desperately seeking for, the Akwes say “Seeing them moving freely in their beds in their own rooms, we were sitting on the top of the world. Since Elizabeth and Mary had been conjoined for 13 months, they were constantly crying while looking for each other. Following their stay at the intensive care unit, Elizabeth has constantly kept her tiny hands on Mary till the morning of the evening that she has re-united Mary for the first time. We owe this unbelievable happiness to the confidence instilled by physicians, nurses, management and all other personnel, who were extremely proficient, and their warm behaviors that had also boosted our mood. Words actually fail to express our happiness. Many citizens are waiting impatiently to hear from and see us in our home country and it is exceptionally pleasing to fly back with a happy ending into a new and a healthy beginning.” 

What did they do? How did they feel?

The road to this ‘most lovely separation’ was paved by rigorous and careful efforts of numerous physicians from many departments, ranging from pediatric neurosurgery to plastic surgery, pediatric surgery, radiology, urology, anesthesiology, cardiovascular surgery and intensive care team, and a gigantic army of healthcare professionals. 

Professor of Pediatric Neurosurgery Memet Özek says “We, the neurosurgery team, started the separation surgery. Since they shared the spinal cord, myelomeningocele, spinal membranes and sacrococcygeal bone, we separated such structures and thus, completed the surgical procedures that are related to our specialty. Even positioning the patient on the surgical table is a detail. Here, we have two fused children and the ideal position of one child is the one that complicates surgery of the other one very substantially! Due to the fusion, we had performed the surgery in a very extraordinary position, may be for the first time in our life, because you cannot position the conjoined twins on the surgical table as you wish and even this fact makes the surgery very distinctive and complex. We are so happy to perform this surgery successfully. But it is also important not to ignore efforts of pediatric physiotherapy team. The team visited them three times a day and thus, these children are recovered regarding movement and gait”, while Professor of Pediatric Surgery Burak Tander adds: “The spinal cord, urinary tracts, rectum and some blood vessels were shared. The rectum was opening to a joint anus. The muscle complex that was regulating the defecation was also conjoined and it was one of the most significant challenges. Colostomy was performed to divide it into two parts. One of the twins did not have a vagina, while other’s vagina was also problematic. A pouch was created during the surgery to construct a vagina in the future. None of them had any uterus or it was extremely underdeveloped. Their digestive and urinary systems, genital system and neurovascular systems were joined. All members of the team reviewed the three-dimensional dummy, which was ordered to perform a flawless separation surgery. Mary was the first to leave the operating theater followed by Elizabeth. It was an incredibly emotional moment for the team, when they saw each other for the first time.” 

Professor of Aesthetic, Plastic and Reconstructive Surgery Hakan Ağır “We carried out procedures to liberate skin, subcutaneous tissues and muscles before the separation surgery of the conjoined twins. We placed tissue expanders in the first phase of the separation surgery at body parts, where the conjoined twins would be separated. It was a preparatory process and the first phase. In the second phase, we had undertaken the role of closing the areas operated on by pediatric surgery and pediatric neurosurgery teams. We also acted as a team to overcome postoperative wound healing problems with general intensive care and infectious diseases teams and with a maximized the nursing care”.

Associate Professor of Anesthesiology Serpil Ustalar Özgen adds: “Our role, as the anesthesiology team, was to have these babies sleep safely throughout the surgery to help our surgeons work comfortable and to recover them again safely. We prepared all equipment in two colors to avoid confusion between two babies before we started the surgery; the team was divided into the ‘Elizabeth team’ and the ‘Mary team’. In fact, 27 hours have elapsed somewhat within an hour for us, because everybody has used all technological means, proceeded very professionally and strongly focused on its role. The babies are, now, very well and they are growing very quickly. I am so happy to be a member of the team that has successfully separated them; it is worthless to see the babies so healthy in their own bodies and singing songs and dancing on their own way.”

Professor of Pediatric Intensive Care Agop Çıtak summarized the intensive care period as follows: “The surgical separation of the twins is a long, complicated and challenging work. This aspect of the surgery dictated adaptation of postoperative care, monitoring and treatment of the babies at the pediatric intensive care unit accordingly. Potential problems were predicted in advance and all preparations were based on such estimations, including rooms, beds, the nurses who would take care of them, medications, blood products and devices. When they were postoperatively admitted to the intensive care unit, all vital signs of twins were closely monitored. A long surgery may pose a risk of infection and we, therefore, focused our attention very strictly on infection. We had maintained proper communication with the surgical team. They were recovered from sedation and weaned from the respiratory device, as there was no problem in their vital signs. After the twins were monitored at pediatric intensive care unit for further couple of days, they were discharged to their room at the inpatient clinic”