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Last Updated: Tuesday, 8 July, 2003, 13:47 GMT 14:47 UK
Surgeons' sorrow at death of twins
Dr Chia Kok Hoong (left) and Dr Eric Peh (right)
There were some unexpected delays during the first phase of the surgery
The announcement that the Iranian conjoined twins Ladan and Laleh had died during surgery, came from the chairman of Singapore's Raffles Hospital, Dr Loo Choon Yong

Dr Loo explained how the marathon surgery to separate the 29-year-old twins, who were joined at the head, ran into complications.

On Sunday morning, 6 July at 0830, Ladan and Laleh underwent an MRI scan to reconfirm that everything was in order before surgery began.

At around 1000, surgery began and the femoral vein was harvested after the saphenous vein was found to be too small.

The cranium was opened over the next few hours and the bypass was connected in two places.

When we undertook this challenge we knew the risks were great, we knew that one of scenarios was that we may lose both of them. Ladan and Laleh knew it too
It continued to Monday 7 July. Bypass was achieved. The flow was maintained and the brain dissection began.

But by 1830 on Monday, the bypass became occluded and there was some congestion, so the team gathered and the specialists studied the problem and discussed with the next of kin in Singapore and gave the following options:

Either to stop the surgery at that point, move them into intensive care, get them off anaesthesia and to plan the next stage - there was of course going to be risk of infection and losing them in intensive care.

Or to continue with the final stage of surgery which we knew would be very very risky.

The team wanted to know once again what were the wishes of Ladan and Laleh.

And we were told that Ladan and Laleh's wishes were to be separated under all circumstances.

Delicate operation

After that the team brainstormed how to overcome the problem, and it was remarkable how they put all their thoughts and expertise together.

The bypass was cleared and an additional shunt was created to reduce the congestion and it worked well.

Professor Ben Carson and Dr Keith Goh continued to dissect the brain which was harder than we had anticipated because they had been together for 29 years.

Dr Loo
As doctors we know that there is only so much we can do and the rest we have to leave to the Almighty

They continued to operate, millimetre by millimetre, right through the night, and up to this morning the dissection was still carrying on.

They tolerated the surgery well. The base of the skull had to be separated and the thick bone was successfully separated.

The twins took 50 hours of general anaesthesia and continuous surgery rather well and we were hopeful but rather cautious.

Separation of the brain of Ladan and Laleh was achieved at around 1330 today. There was some bleeding but for a while they tolerated it well. Transfusion to both Ladan and Laleh was given rapidly.

Surgery continued on the now separated Ladan and Laleh.

But at around 1400 Ladan's circulation began to fail. The specialists battled to save her life but unfortunately she succumbed at around 1430.

In the meantime Laleh was critical but holding on. Surgery to her brain continued and she continued to receive blood transfusions.

Prayers

However, at about 1545 her circulation began to fail also. The whole team did everything to save her, but unfortunately we lost her at 1600.

When we undertook this challenge we knew the risks were great. We knew that one of scenarios was that we may lose both of them. Ladan and Laleh knew it too.

We were hoping and trying to do better than the worst odds, but alas we didn't make it.

Throughout Operation Hope we are grateful for the grace of God which has been with the twins and with the team.

We are very grateful and thankful for the efforts and sacrifice of so many specialists, doctors technicians, nurses and ordinary people all united with one common purpose - to do something, anything to help Ladan and Laleh and fulfil their wishes.

I think we also want to thank the Iranian Government for their moral and financial support and the Iranian community in Singapore and worldwide. They rallied around the sisters and the medical team and they have been extremely supportive.

We also want to thank so many people for their prayers whether they are Christians, Buddhists, Hindus or Muslims. Everybody had been praying for the twins and we are very grateful because as doctors we know that there is only so much we can do and the rest we have to leave to the Almighty.

Our sympathies go to the Bijani family and all the family members. But Ladan and Laleh have a much bigger family than in Iran. All the people in Iran, all the people in Singapore, all the hearts that they have touched.

I hope all of us can remember them laughing and smiling as they proceeded on this journey.

Thank you and I wish I had better news for you.



SEE ALSO:
Iranian twins die in surgery
08 Jul 03  |  Asia-Pacific
Conjoined twins separated in Dhaka
26 Jun 03  |  South Asia
Separated twins 'open their eyes'
09 Aug 02  |  Americas
Siamese twins die in Bangladesh
30 Jan 02  |  South Asia
Message from Bijani twins
06 Jul 03  |  Asia-Pacific


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