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Last Updated: Monday, 29 September, 2003, 15:33 GMT 16:33 UK
Iranian twins surgeon has no regrets
Ladan and Laleh Bijani
The Bijanis longed to separated
The surgeon in charge of the unsuccessful attempt to separate Iranian conjoined twins believes others will benefit from the lessons learned.

Dr Keith Goh headed a team of 24 doctors and 100 medical assistants who operated on Laden and Laleh Bijani at the Raffles Hospital, Singapore, in July.

The women, who were joined at the top of their skulls, were determined to push ahead with surgery despite knowing full well that it was highly risky. In fact, surgeons admitted there was only a one in six chance of a good outcome.

Fifty hours of complex surgery ended in tragedy when both women died. Although surgeons were able to separate the twins, they were unable to staunch their blood loss.

Doctors prepare to free Ladan and Laleh Bijani - Conjoined twins

As the operation progressed, it became clear the brains had fused together after 29 years sharing the same skull cavity, and the separation would not be as straightforward as anticipated.

Surgeons spent some 21 hours cutting the twins' brains apart "literally millimetre by millimetre" - something that they had not expected to have to do.

Dr Goh told BBC World's HARDtalk programme, there was a "stunned silence" in the operating theatre when it became clear the procedure would fail.

"Some of the nurses who had grown so close to the girls were in tears. They were sitting down crying their eyes out," he said.

"Some of the anaesthetists were unable to move; they were just sitting there staring."

Soul searching

Dr Goh told the programme that that he prayed for the well-being of the 29-year-olds beforehand and had a week of soul searching afterwards about whether he had done the right thing.

"I asked and prayed about this quite intensely. At the end of doing my own post-mortem on the case, I think that looking back at the situation it was the correct thing to do.

"It was done with the best of intentions, and with the best available medical plan that anybody could have made.

"Although the outcome was the death of the twins, I think that we learnt so much from this case that it would benefit patients in future, and that it was probably an operation that carried a lot of benefits."

Dr Goh said if approached by others in the same position, he would take the same decision to operate.

"The twins suffered from a very severe congenital malformation. And it was a malformation that caused them a great deal of suffering.

"So I think that if I was approached to help a similar set of twins in the future, I would certainly try my best to help them.

"Of course, from what we know of the twins' anatomy and how their physiology is affected by being in a conjoined state, the techniques that we use in the future case will probably be different from what we used for Laleh and Ladan."

  • This edition of HARDtalk will be shown on BBC World on Tuesday 30 September at 0330 GMT, repeated at 0830, 1130, 1530, 1830 and 2330 GMT.

    In Asia-Pacific, the programme can be seen at 1630 Singapore time, repeated at 1930, 2330 and 0230 Singapore time.

    Iranian twins die in surgery
    08 Jul 03  |  Asia-Pacific
    Surgeons' sorrow at death of twins
    08 Jul 03  |  Asia-Pacific
    Message from Bijani twins
    06 Jul 03  |  Asia-Pacific
    Conjoined twins
    06 Jul 03  |  Medical notes
    Mourning the loss of the twins
    08 Jul 03  |  Middle East

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