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Last Updated: Tuesday, 14 October, 2003, 10:50 GMT 11:50 UK
Why are there so many conjoined twins in the news?
In the latest story of conjoined twins to hit the international headlines, Egyptian twins Mohamed and Ahmed Ibrahim have undergone a successful operation.

The two-year-olds now face independent futures but ones which will be beset by years of reconstructive surgery.

They are just the latest set of twins to make big news.

  • Adult Iranian twins Laleh and Ladan Bijani - also joined at the head - died after a three-day operation in July

  • Two weeks later, the same hospital in Singapore successfully separated a pair of South Korean twins who were joined at the spine

  • In 2000, the case of twins Jodie and Mary, from the Maltese island of Gozo, highlighted the ethical dilemmas involved in the separation of conjoined bodies. Their parents believed that separation was "not God's will", but the Court of Appeal ruled that the twins must be separated to ensure life for Jodie, even though the operation resulted in the death of Mary.

  • Last weekend an Italian surgical team operated on four-month old conjoined twin girls from Greece. The girls were joined at the temple, making it less complex than the Egyptian twins who were joined at the top of their heads.

But what is the cause of the flurry of cases being reported? Is it a result of advances in surgical procedures or mere coincidence?

Survival

The birth of conjoined twins is not, of course, a new trend; the earliest documented case dates back to 1100.

It is estimated that one in every 200 deliveries of identical twins is conjoined; only 35% of those survive their first day.

But over the years, survival rates have improved as a result of more accurate imaging studies and better anaesthetic and operative techniques.

I suspect advances in surgery have a lot to do with several cases recently reported. I think such cases did occur before but no-one was able to deal with them
Dr Gary Steinman

Advances in the fields of paediatric surgery, urology, orthopaedics, anaesthesiology and neurosurgery are widely credited for the rise in confidence of surgical teams to attempt complicated operations.

With advances in imaging doctors can chart a potential "plane of separation" - a dotted line weaved through the tissues which, if cut, maximises the chances of safe separation.

The operation on the Iranian twins marked the first time since 1952 that surgeons had tried to separate adult craniopagus twins - siblings born joined at the head.

The sisters had been turned away by German doctors in 1996 because of the high risks involved in the surgery.

Surgical development

But operations that were unthinkable even to attempt a decade ago are now considered by surgeons.

Recent developments have been likened to the early days of open heart surgery, a parallel Dr Gary Steinman, who has conducted several research projects on twinning and conjoined twins, agrees with.

"I suspect advances in surgery have a lot to do with several cases recently reported. I think such cases did occur before but no-one was able to deal with them.

"There is no doubt that quality of surgery available has increased dramatically," he adds.

The Bijani twins
The Bijani twins lost their lives during surgery to separate them

The surge in such cases being reported also arises from the birth of conjoined twins in 1996, believes Diane Degeraty, co-founder of the support group Conjoined Twins International.

In 1996 her daughter Michelle gave birth to twins who were joined at the chest. The operation was successful and the girls are now healthy school children.

At the time of the birth Diane and her husband Will knew nothing about conjoined twins.

"Our daughter decided to try and become a kind of pioneer and find out more about why these kind of babies are born.

'Hidden'

"She decided to be friendly to the media and as soon as her story went worldwide people started to come forward."

The Degeratys then set up the support group to advise and assist other parents going through the same ordeal.

A clearer picture of why so little had been said on conjoined twins soon began to emerge. The Degeratys heard stories of how some children had been hidden through the guilt and embarrassment of their parents.

"To our amazement we discovered that conjoined twins were basically considered freaks."

In many societies conjoined twins have traditionally been seen as exactly that. They are likened to creatures and left to die.

So why the media interest now?

"It's not a morbid fascination. Most parents and mothers are fascinated by baby stories," Diane adds. "Just the fact that these babies are innocent and helpless people become really compassionate for them."


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