Relief, joy as twins start new life apart
WHEN surgeons finally got the answer to the question they have long asked – and feared – a sense of relief swept over Royal Children’s Hospital’s Theatre 6.
Since first setting eyes on a set of rudimentary scans from Bhutan, Melbourne’s Royal Children’s specialists wondered exactly what was going on inside Nima and Dawa Pelden’s conjoined bodies.
After a year-long effort to save the 15-month-old sisters, the massive team got the per- fect answer. “Our greatest challenge, we always knew, was: ‘What are we going to find when we first went into the abdomen?’,” head of paediatric surgery Dr Joe Crameri said.
“Once we realised that we had the ability to divide the liver without compromising the girls and ultimately that we did not have to do anything fancy with the bowel. That was certainly a sense of relief for us.
“All the hard work and efforts over the past weeks really paid dividends (yesterday).
“We saw two young girls who were very ready for this surgery, who were able to cope with the surgery, and are recovering and doing very well.
“I see it as a sense of relief, we always felt confident we could achieve this.”
From the moment yesterday’s process began, Nima and Dawa began acting like independent girls with one succumbing to anaesthetic quickly, while the other took more than two hours.
When surgery did begin the team – which swelled to 25 during some sections of the six-hour operation – were overjoyed to find there was no significant bowel attachment requiring extensive surgery but rather just overlapping or tangle organs.
As Dr Tom Clarnette then led efforts to separate the twins’ shared liver he found some issues were a little more significant that they expected – but more relief when both had the necessary “plumbing” and there were no bleeding difficulties.
“We were never certain of exactly what we were going to find but we were pleasantly surprised we didn’t get any unexpected curve balls,” he said.
Then, just before 12.45pm yesterday, the girls were officially separated and stable.
The crucial effort to reconstruct the girls’ now individual bodies saw the theatre and surgery team split in two with surgeons Dr Crameri and Dr Liz McLeod taking care of Nima as Dr Clarnette and Dr Michael Nightingale rebuilt Dawa.
Reconstruction of the abdomen was thought to be the day’s biggest challenge, however both girls had enough muscle and skin to close over the gap in their chest.
Although it was hoped the girls could avoid the need to recover in intensive care, the decision was made about 5pm to move them into the highneeds area, though they continue to recover very well and are expected to be in hospital for about a week.
“It is a relief and it is also joy. There is nothing better with any operation that to be able to go to the parents and say ‘we have been able to look after your child, we have been to do what we set out to do and are confident they will recover from this and go forward’,” Dr Crameri said.