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The BBC's Jonathan Head:
"Two teams of surgeons are working round the clock"
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The BBC's David Bottomly
"The hospital is playing its cards close to its chest"
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Monday, 9 April, 2001, 07:12 GMT 08:12 UK
Siamese operation into fourth day
Family photo of the twins
Jamuna and Ganga's brains are fused at some points
An operation in Singapore to separate Siamese twins, originally scheduled to last no more than 36 hours, has entered its fourth day.

The Nepalese twins, Ganga and Jamuna Shrestha, are joined at the top of their heads and share the same brain cavity, causing them to face away from each other.

But this means they also share some blood vessels - all of which have to be traced and separated.

A spokeswoman for Singapore General Hospital said both girls were "doing fine" and that the operation - which is being followed closely in the country - was expected to continue late into Monday.

It's a very complex operation... you can hardly estimate the time

Hospital spokeswoman
They must be split to survive and have the chance of a normal life.

The two teams of doctors involved in the operation began their work at 1600 (0800 GMT) on Friday.

The paediatric neurosurgeon in charge of the separation, Keith Goh, said only four operations of this kind had been performed before and only one of them successfully.

In this case, however, he said there was good potential for recovery.

Meticulous surgery

A hospital statement said the complex interconnection of blood vessels required "a meticulous and paced disconnection, in order to allow time for the brains to adapt".

"The operation is proceeding smoothly and slowly, with no complications so far," it said.

Since the twins arrived in Singapore from Nepal last October, doctors have been rehearsing the procedure by performing virtual surgery with the aid of computer technology.

Only four operations of this kind have been performed before
During the operation, surgeons have to determine which part of the brain belongs to which girl to ensure they identify the correct speech and logic centres.

Doctors have admitted that some brain cells will inevitably be damaged in the operation, but do not yet know if that will translate into functional problems.

The plight of the Shrestha family, who come from a rural village near the Nepalese capital Kathmandu, has captured media attention in Singapore.

While the doctors are donating their services, an appeal for $56,000 to cover medicines and other hospital expenses raised nearly seven times that amount in Singapore.

The surplus will be held in a trust to cover further medical treatments that Ganga and Jamuna may need.

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See also:

06 Apr 01 | Asia-Pacific
Surgery to separate Siamese twins
19 Jan 01 | Europe
Siamese twin Mary laid to rest
07 Dec 00 | Health
Siamese twin op details revealed
25 Aug 00 | Q-S
Siamese twins
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