Complications hit twins operation

There were some unexpected delays during the first phase of the surgery

Surgeons carrying out an operation to separate conjoined Iranian twins have warned that the operation will take longer than anticipated.

Neurosurgeons have discovered that the brains of Ladan and Laleh Bijani have become tightly fused over the past 29 years.

But doctors have overcome their first big hurdle, successfully re-routing a shared vein that drains blood from the twin sisters' brains.

A team of 28 doctors and 100 medical assistants are involved in the surgery to separate the twins, who are joined at the head.

Doctor Prem Kumar, speaking at a press conference at Raffles Hospital, Singapore said: "The brains are very adherent to each other. That means we have to be very careful. You can't just tear them apart."

See how the operation on the twins is being performed

"The neurosurgeons have to cut through the brains very carefully, literally millimetre by millimetre."

"In the process, we have encountered a lot of blood vessels and a lot of tissue that is taking a long time to separate," Dr Kumar said.

The operation is being further complicated because the blood circulation between the twins is unstable.

"There is still blood flowing between the two of them," Dr Kumar said.

"It means that the blood pressure needs to be monitored all the time."

"We anticipate that the process of separating the brain will continue well into the night and into tomorrow."

The operation began before dawn when surgeons began stitching a vein taken from Ladan's thigh to one of the twin's brains to compensate for the removal of the shared vein, chief surgeon Dr Kumar said.

If God wants us to live the rest of our lives as two separate independent individuals, we will

Ladan Bijani

Message from Bijanis

Surgeons are working simultaneously in tight spaces in front of and behind the twins, who are sitting in a custom-built brace connected to an array of lines feeding them intravenously and monitoring their vital signs, he added.

Iranians living in Singapore and around the world have gathered at Raffles Hospital to pray for the Bijani sisters as they undergo the surgery.

"I hope it will be successful and we pray a lot and we read the Koran," Azimi Shahin, 50, a businessman who has lived in Singapore for 20 years, said after taking time off work to come to the hospital on Monday.

Quality of life

After the separation, the doctors will perform the final surgical reconstruction of the skin and soft tissue on the exposed area of their heads, using muscle and skin grafts.

The twins were told they had only a 50-50 chance of survival, but said they are willing to risk death for the chance to lead separate lives.

The operation marks the first time surgeons have tried to separate adult craniopagus twins - siblings born joined at the head - since the operation was first successfully performed in 1952.

German doctors had turned away the Bijanis in 1996, deeming the operation to be too risky.

The chief surgeon at Raffles, Dr Keith Goh, said he had weighed up quality of life against risk before deciding to proceed.

The Iranian sisters said they understood the risks, but were still keen to go ahead with an operation they have wanted for years.

Now aged 29, they have become well-known in their home country for their courage and academic success - both are law graduates.

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