Surgery comes to an end for three-month-old Siamese twins

Muninggar Sri Saraswati, The Jakarta Post, Jakarta

Baby Iksan looks weak. Several tubes poke from his tiny body. He is alone in a sterile room in the children's intensive care unit at Cipto Mangunkusumo (RSCM) general hospital in Central Jakarta.

The almost-three-month-old has no idea that his formerly conjoined brother, Ilham, was buried Monday in nearby Kemiri public cemetery.

Ilham died of heart failure just hours after the pair were separated during surgery on Sunday.

"I have no more tears left," their mother, Nur, said, several hours after Ilham's burial.

Both Nur and his husband, Andi, looked resolute as they faced up to their loss.

"I have no family here, but I couldn't afford to have Ilham buried in our hometown in Riau. I know I won't be able to visit his grave in Jakarta regularly in the future, but I don't want to prolong his suffering. It could have taken days to take him home," the 20-year-old mother said in a soft voice.

According to Nur, a team of doctors at the hospital decided to proceed with the operation when Ilham's heart condition continued to worsen. The conjoined twins were attached at their chest and abdomen. They had two hearts, two livers and two pairs of lungs.

"The doctors told me that they must operate immediately as Ilham's condition could affect Iksan's chances of survival. We permitted them to do so," Nur said.

Nur gave birth to her first sons by caesarean section on June 6 at a hospital in Perawang, two hours drive from Pakanbaru, Riau. The young mother had no idea she had delivered a pair of conjoined twins until a month after the birth.

"Nobody told me until finally my husband said that I had a conjoined twin babies. Later the doctors said that my babies were healthy and I would be allowed to see them as soon as I recovered," said the housewife, who was hospitalized for a month following the surgery.

Nur said that she was not shocked at the news.

"I didn't know why I gave birth to twins. There have been no twins in either my family or my husband's family. However unusual they are, they are my babies," she said.

She admitted she had no idea about the possibilities of surgery to separate the twins because her husband was only a construction worker.

Fortunately, a social foundation called BK3S based in Pakanbaru voluntary offered financial assistance for the surgery.

The foundation flew the family to Jakarta 15 days ago. Having no relatives in the capital city, Nur and Andi have had to sleep in the corridor outside the intensive care unit.

Nur quoted the doctors as saying on Monday that Iksan's condition was stable. "He will likely survive, but we must wait until he fully recovers." She said she had seen Iksan just twice since the surgery.

The doctors at the intensive care unit could not be reached for comment.

Iksan and the late Ilham were the latest conjoined twins to arrive at the hospital.

There have been two other recent cases of conjoined twins being treated at the hospital.

Dedeh 1 and Dedeh 2 died in June before they were operated on while Ferina and Ferini, who were born in April, are scheduled to undergo surgery when they reach six months of age.

The RSCM has operated on 15 Siamese twins since 1970. All operations have supposedly been successful.

RSCM director Dr. Merdias Al Matsier said the separation surgery was likely to succeed if each of the babies had complete and good organs.

Siamese twins are identical twins who develop with a single placenta from a single zygote. The twins always have the same sex.

The cause of the condition is unexplained but could relate to the failure of the zygote to separate on the 13th day after fertilization.

Merdias has said that there is one pair of Siamese twins born for every 200,000 live births. Females were more likely to be Siamese twins than males, at a ratio of three to one, he said.

There are several types of conjoined twins based on the point at which they are attached. A pair of Siamese twins can be attached to each other at the head (craniopagus), chest (thoracopagus) or back (pygopagus).