Technology comes into focus as MNH separates conjoined twins

Formerly conjoined twins with their mother, Ms Esther Simon (left), and Muhimbili National Hospital (MNH) maternity ward supervisor Stella Rugashara during a press briefing at MNH. The twins were separated at the hospital on Sunday. PHOTO | OMAR FUNGO

What you need to know:

  • This is the first successful surgeon to separate conjoined twins. In 1994 the hospital carried a similar operation but one of the conjoined twins died.
  • Since then the hospital has been referring conjoined twins abroad for operation.

Dar es Salaam. Doctors at Muhimbili National Hospital (MNH) say the assessment and separation of conjoined twins is now easier and more successful due to advancing technology but the hospital fails to handle complex cases due to a shortage of specialists who can operate on children.

Yesterday, MNH’s executive director, Prof Lawrence Museru, announced that a set of conjoined twins were successfully separated as the national referral facility made the second successful separation of conjoined twins after 24 years.

The twins were conjoined on the abdomen and a section towards the chest. This, in medical terms is known as omphalopagus.

Dr Petronilla Ngiloi, a paediatric surgeon at MNH who was in the surgical team, told The Citizen that the twins, born in Kisarawe District were successfully separated with the assistance of a consultant paediatrician from Ireland, Prof Martin Corbally.

Dr Ngiloi said that doctors at MNH did all the necessary tests using hi-tech imaging facilities such as MRIs, CT scans and ultrasound and could thus locate the twins’ fused organ; something that wasn’t possible in the past when the hospital hadn’t invested in such technology.

“This could not be done more perfectly like this many years ago. We used to do it somehow blindly,’’ narrated the surgeon who has been in the trade for over 30 years now.

“In 1994 when Muhimbili performed its first conjoined twins separation, technology hadn’t advanced as it is today. This partly explains why the past operations weren’t very successful,’’ said Dr Ngiloi, who participated in the 1994 separation of conjoined twins.

“We should be able to perform more complex operations to separate twins, even those whose hearts, heads or chest organs are fused. But this is possible only if we have more specialists in diverse fields of medicine who can operate on children,” she pointed out.

For such operations to be successful, researchers published the 1994 case study in the East African Medical Journal and emphasised on the role of teamwork in the evaluation, separation and care of conjoined twins for a successful outcome. The report was titled The Conjoined Twins of Shinyanga, Tanzania: Case Report.

On this, Dr Ngiloi says, “We need paediatric surgeons to be able to handle the procedures as a team. Currently we are only three. But we also need more heart surgeons for children, neurosurgeons and anaesthesiologists with skills to deal with children. If we have all these, we won’t have to refer patients abroad anymore.”

In the latest case, a set of conjoined twins weighing two kilogrammes at birth were separated in a five-hour operation that involved a team of ten experts from various medical fields.

Born on July 12, the twins-both boys, were later admitted at MNH since July as they awaited surgery. Surgeons were still weighing in on the risks and benefits of carrying out the procedure as they looked to avoid the risk of death or any other problem that may occur after separation.

Dr Ngiloi says it is important to carry out the surgeries locally as it saves the cost of sending them abroad. “In 2001, we referred a case of conjoined twins to South Africa and it cost around Sh47millinon (Rd300, 000),’’ she revealed.