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Conjoined twins have been making the news this summer: surgeons executed groundbreaking procedures to separate two sets, one in Vatican City and one in Vietnam.
Meanwhile, the oldest living set of conjoined twins died at 68 – men who might have been able to live separate lives if born today.
Conjoined at the back of the head, twin girls from the Central African Republic are making a full recovery after their June 5 separation surgery in Vatican City’s Bamino Gesú hospital.
The surgery to separate the girls -- Ervina and Prefina Bangalo, age two – lasted 18 hours and involved 30 doctors and nurses, according to a press release from the hospital. The surgery itself was more complex even than most twin separation procedures because the twins shared brain blood vessels and skull bones.
Nothing similar appears in any medical literature, according to the hospital.
Ervina and Prefina’s separation was a series of surgeries starting in May of 2019. Neurosurgeons needed to craft new blood vessels for the girls’ brains and allow time for them to grow and heal. The final separation surgery happened on June 5, the release states.
In July, a team of 100 medics in Vietnam’s Ho Chi Mihn City Children’s Hospital separated the 13-month-old Truc Nhi and Dieu Nhi. The girls were joined at the hip, but their struggle isn’t over. Surgeons will have to help each grow her own digestive system and reconstruct each girl’s pelvis with follow-up procedures, according to the Daily Mail.
As these four conjoined twins started their lives in newly separate bodies, the oldest living set of conjoined twins passed away at 68 in Dayton, Ohio. Ronnie and Donnie Gaylon were a fixture of the community – the Dayton Daily News kept up with their lives periodically as they moved in with a brother and retired from the carnival circuit in 1991, and later after they received global recognition. The Gaylon brothers viewed their designation at 63 as the longest-living conjoined twins by The Guinness Book of World Records as a source of pride, the Daily News reported in the Gaylons’ July 6 obituary.
How Do Conjoined Twins Happen?
Conjoined twins develop when an embryo does not fully separate to form two individual bodies, but the reason for this is not clear, writes MedicineNet author and editor Melissa Conrad Stöppler, MD.
There are no known risk factors or prevention measures for women wishing to avoid conceiving conjoined twins, and women who have one set are not at higher risk for birthing another, she said.
Luckily, the risk of having conjoined twins is small. They occur in around 1.5 per 100,000 births worldwide, Dr. Stöppler said. Females are affected more often than males; about 75% of conjoined twins are female.
The term "Siamese twins" was used in the past to refer to conjoined twins based on a famous pair of twins from the 19th century, but this term is no longer used in the medical literature, Dr. Stöppler said.
The medical terms used to describe the types of conjoined twins are based on the specific location of the fusions, Dr. Stöppler said.
Craniopagus twins are joined at some area of the skull, typically the back, top, or side of the head. They share a portion of the skull but usually have separate brains.
The girls separated in the Vatican City in June were craniopagus, according to the hospital press release.
Ischiopagus twins are joined at the pelvis, and may be joined facing each other or side to side. They may share parts of the gastrointestinal system, genital tract, or urinary tract, Dr. Stöppler said.
This is the classification of the little girls separated in Vietnam in July. The Gaylon brothers were also ischiopagus.
What Is the Outlook for Conjoined Twins?
Conjoined twins are delivered by Cesarean section (C-section), typically at a somewhat earlier gestational age than full-term pregnancies, Dr. Stöppler said.
After birth, the decision whether to attempt surgical separation depends on many factors, such as the:
- Extent to which the twins share vital organs
- Types of reconstructive surgery that will be needed
- Likelihood that separation will be successful
The outlook for conjoined twins depends upon the extent and location of the fusion of body parts. In many pregnancies, conjoined twins die in utero or do not survive long after birth. Stillbirth affects about 40% of sets of conjoined twins.
In other situations, the conjoined twins survive, and surgical separation may be successful in some females. The birth defects may be severe and life threatening, particularly after surgical separation, for some conjoined twins.
Pregnancy risks for women carrying conjoined twins include polyhydramnios (excessive amniotic fluid), preterm birth, and fetal death (stillbirth).
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