The Rotary Club of Toronto-Leaside

The following article appeared in the Toronto Star. What was not mentioned was that the twins came from Howard Hospital where they were cared for by Dr. Paul Thistle

Surgery Separates Twins

Mon Mar 7,  2005,   4:12 PM

HOSPITAL FOR SICK CHILDREN PHOTO BY DIOGENES BAENA

After the twins were separated at 11:29 a.m., the procedure split into two simultaneous operations, each with its own team.

Brothers from Zimbabwe who shared a liver can now live apart Hospital for Sick Children celebrates successful operation.  (ELAINE CAREY, MEDICAL REPORTER)

Tinotenda and Tinashe, the seven-month-old conjoined twin boys from Zimbabwe, are now two little individuals after being successfully separated in a five-hour operation at the Hospital for Sick Children.

A surgical team of 25, including two general surgeons, two plastic surgeons, two anesthetists and eight nurses, led by Dr. Jacob Langer, completed the operation at 2:40 p.m. yesterday.

After the first two hours, the twins, who were joined at the abdomen and shared a liver, were separated. And then, one operation became two.

"I am pleased to announce that everything went well, really due to a co-ordinated team," Langer told a news conference following the surgery.

Looking scared and nervous, 40-year-old Elizabeth Mufuka, the babies' mother, said through an interpreter that she wanted to thank everyone who took part in the operation and "may God bless them all."

Langer, chief of general surgery at Sick Kids, said the operation went as planned with no unexpected complications.

Although they are in stable condition, the babies will be in intensive care for up to a week and will have to be monitored carefully for any risk of infection or bleeding, he said.

Asked about the seriousness of the operation, he said it was of "medium ease" — not as easy as some where twins are joined by only a small bridge of tissue, but far less difficult than those with very complex abnormalities.

Conjoined twins occur in about one in every 50,000 pregnancies and few survive.

"They challenge our concept of what it is to be an individual," Langer said. "These two people are never away from each other. It makes us question what it is to be a person."

Both the twins "have wonderful personalities," he said. "And they're wonderful together: you can imagine them looking at each other all day. You couldn't feed one without the other, or the other would go ballistic."

Their mother added that they are "both voracious feeders and one of them is always observing."

If one was asleep, the other would stay awake watching, added Langer. "One would always be on watch."

The twins arrived at Sick Kids on Dec. 2 with their mother and a nurse.

They were delivered by Caesarean section by Dr. Rachel Spitzer, a fourth-year resident in obstetrics and gynecology at the University of Toronto who happened to be in Zimbabwe last summer on a three-month rotation.

"I was absolutely thrilled and honoured to be able to be there to view the operation today," she said.

"It's exciting to see this from the start to hopefully a new start as well."

They are the 10th set of conjoined twins to be separated at Sick Kids, the only hospital that could offer the Zimbabwean twins the medical expertise and financial support from the Herbie Fund to cover medical expenses.

The operation involved separating their joined livers and severing a joint artery that was feeding into Tinotenda, which left Tinashe much smaller, said Langer. Then their abdomens and upper bowels were separated and extra skin was pulled up from the lower part of the trunk over the incisions.

That was one of the trickiest parts of the operation, said Langer, and couldn't be done without plastic surgery. Both had a skin expander, or balloon, implanted under their skin before the operation to allow extra skin to grow. But the area became infected and it had to be removed.

The smaller twin didn't have quite as much skin, so a large flap had to be cut from the lower abdomen and sewn over the chest wound, said plastic surgeon Dr. Ronald Zuker.

The operation had to be delayed a month because the boys were undernourished when they arrived and after the infection they developed influenza.

They also have cleft lips and palates, and Zuker plans to wait a few months to surgically correct that problem before they go home.

All the specialists involved in the operation donated their time, but the medical care will still cost an estimated $200,000 through the Herbie Fund. The Canadian Salvation Army paid the cost of flying the mother, twins and nurse to Toronto, while other organizations are picking up their living expenses.

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