After 14 hours of surgery, twins' long fight for life has just begun

Parents face anxious wait despite successful operation to separate conjoined siblings
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Indy Lifestyle Online

Angie and Azzedine Benhaffaf, parents of the conjoined twins successfully separated in a 14-hour operation at Great Ormond Street Hospital, were yesterday beginning a vigil by their sons' bedsides that could last weeks.

The four-month-old twins, Hassan and Hussein, who were joined at the chest and, it is believed, the liver – contrary to reports that they did not share an organ – face a long path to recovery. Although the operation was a technical success, it is impossible to tell how the twins will fare after separation.

Their parents, delighted at the immediate outcome of the surgery, said they had "won the battle of their lives". But the reality is there will be many battles ahead as the twins' surgical wounds heal and their bodies adjust to independent lives.

The length and complexity of the operation – it took 14 hours and required 20 medical staff including four surgeons and four anaesthetists – is an indication of the seriousness of the procedure they have undergone.

The next days will prove crucial for the twins. Their condition is likely to fluctuate hourly, as with all babies treated in intensive care.

They will be monitored around the clock by teams of doctors and nurses who will adjust their drugs and fluids according to how they respond.

Edward Kiely, the consultant paediatric surgeon who led the team, and who is the most experienced surgeon in the country for this kind of operation, gave little away yesterday. "The twins are in intensive care and are sedated but stable. We are pleased with how the operation went," he said.

The Benhaffafs, who came with their older daughters Malika, four, and Iman, two, from east Cork in the Irish Republic to be with their sons for what is expected to be a four-month recovery period, said the "sun was shining" for their "two little fighters".

"Words cannot express the relief and love we feel for our two boys. We thank God, we thank the surgeons and the gifted team at Great Ormond Street Hospital, and we thank from the bottom of our hearts the Irish nation and everyone who prayed for our beloved twins," they said. A fund was set up in Ireland to help the family cover their medical costs.

No pictures of the separated babies or details of the operation were released yesterday. In a statement, Great Ormond Street said the family was being filmed by the Tonight programme for ITV1 and would "not be doing any interviews at this time".

The surgical team at Great Ormond Street has a worldwide reputation for successfully separating conjoined twins. It has dealt with 21 separations and nine inoperable cases. If the liver is the only organ that the twins share, their chances should be relatively good. The liver is one of the few organs that can regenerate and separating it should be relatively simple. The main risk is of haemorrhage – the liver is suffused with blood and supplied by a network of blood vessels.

However, separating conjoined twins is always risky. Experience at Great Ormond Street shows that where the separation is performed as an emergency, only one in four babies survive. Where it is planned, as in this case, the survival rate rises to 80 per cent.

In a recent previous case, Faith and Hope Williams, born in November 2008, were joined like Hassan and Hussein Benhaffaf, at the chest. However, Faith and Hope shared part of their circulatory system and intestine, as well as their liver, and had heart defects.

As the girls' condition deteriorated, they underwent emergency surgery to separate them, which lasted 11 hours, when they were a week old. Though the surgery was a technical success, Hope died on the operating table when her lungs were unable to sustain her on her own. Faith died four weeks later.

Hassan and Hussein, like Faith and Hope, were born at University College Hospital, London, before returning to their home in Ireland to gather strength for the separation attempt.

Conjoined twins are extremely rare, occurring in as few as one in every 200,000 live births. Their mother, Angie, wrote a poem in which she said the twins had "fought to be here" and the operation to separate them was their "final battle".

Although Hassan and Hussein underwent a longer operation than Faith and Hope, their chances are better because the surgery was not carried out as an emergency. But their parents, and their medical team, face an anxious time ahead.