Family joy at twin separation

Relatives and friends prayed for a successful operation

The family of two-year-old conjoined twins have been celebrating a successful operation to separate them.

Surgeons worked for over 30 hours to divide the heads of Mohamed and Ahmed Ibrahim from Egypt, teasing apart a complex network of blood vessels.

"When somebody came up and said 'We have two boys', the father Ibrahim jumped to my neck and he hugged me and he fainted," said the twins' Egyptian doctor Nasser Abdelal.

The boys' successful surgery was performed at the Children's Medical Center in Dallas, USA.

'Only chance'

The team of surgeons told a news conference that the procedure had gone as hoped, but warned that the boys were not out of danger yet.

They will be kept in a drug-induced coma for several days to reduce brain swelling, and face years of reconstructive surgery on the areas where their skulls had fused together.

MEDICAL HISTORY Born by Caesarean section in Qus, Egypt, 2 June 2001 Arrived in Dallas in June 2002 Tissue expanders inserted under skin in April 2003 to prepare for reconstruction The twins are now in a critical but stable condition Concerns include the risk of infection and how the wounds will heal Ethics of separating twins Conjoined twins

The boys' relatives and friends in their home town of al-Homr, near the southern Egyptian city of Qus, have been praying for a successful outcome.

The family decided to go ahead with the operation, knowing there was a risk of brain damage or death to one or both the twins.

But they said it was the only chance the boys had of a normal life.

Joined at the crown of the head since birth, the boys had trouble closing their eyes, moving their necks and swallowing.

They could not stand on their own and would have faced progressive loss of functions had they remained as they were.

Italy success

In Italy doctors also successfully operated on twin girls joined at the temples, it has emerged.

The four-month-old twins, from Greece, were separated in a 12-hour operation performed by Italian doctors in a Rome hospital.

Doctors said the operation had been less complicated than that of the Egyptian boys because the girls did not share internal organs.

The girls are said to be recovering well in intensive care, although doctors told French news agency AFP that special precautions against infection would be taken for the next few days.

News of the girls' operation had been kept low profile because the parents had insisted on secrecy to protect their identities.

'No surprises'

Doctors spent a year assessing the chances of successfully separating them. They carried out tests on the boys and visited the team who operated on Guatemalan twins last year.

The separation of the Bijani twins ended tragically

"Armed with that, plus some very detailed planning, we felt more comfortable proceeding," said neurosurgeon Dr Kenneth Shapiro, who led the surgical team.

The twins have separate brains, but shared a complicated web of blood vessels and circulatory systems that feed the blood to the brain.

The five neurosurgeons completed the most difficult and dangerous part of the operation to physically separate their blood vessels on Sunday morning - about 26 hours after the twins entered the operating theatre.

A team of cranial and facial surgeons were then brought in to repair the damage to their skulls, using tissue from their thighs.

The entire operation took 34 hours and involved a team of 40 doctors, nurses and other staff.

This is the first operation to separate twins joined at the head since the deaths of Iranians Laleh and Ladan Bijani in July during separation surgery in Singapore.