Conjoined twins die during surgery to separate them

Ladan and Laleh Bijani, the Iranian sisters joined at the head, died on a hospital operating table yesterday, shortly after almost two days of complex surgery to separate them.

Surgery on the conjoined twins' brains, which were firmly adhered together in their single skull cavity, meant the sisters were finally lifted apart - for the first time in their 29 years. Within hours both were dead from massive blood loss.

Doctors at Raffles hospital in Singapore, who said they had agreed to attempt the separation only because of persistent demands from the sisters, were dismayed at the loss of two women whom they had come to know over months of pre-operative tests and counselling.

"When we undertook this challenge, we knew the risks were great. But we were hopeful. Ladan and Laleh knew the risks too," said Dr Loo Choon Yong, chairman of the hospital. "As doctors there is only so much we can do as the rest we have to leave it to the Almighty."

In Iranthe news was greeted with shock and grief. Television programmes were interrupted to broadcast the news. The President, Mohammad Khat-ami, had pledged on Monday to pay the cost of the operation, estimated at $300,000 (£180,000).

The operation, led by the neurosurgeon Dr Keith Goh, ran into several complications and took longer than expected. The women's blood pressure had been fluctuating and surgeons discovered the brains were more closely linked than had previously been thought. The team was unable to stem the bleeding after separating the brains, which had proved difficult to prise apart.

Ladan began to lose blood at around 2pm (7am British time), and died at 2.30pm, doctors said. Brain surgery continued on Laleh, who died at 4pm.

The twins had been turned away by Madjid Samii, president of the International Neuroscience Institute in Hanover, in 1996, who said the operation was too dangerous. Medical ethics experts yesterday defended the decision of the Singaporean team to go ahead.

Michael Wilks, chairman of the medical ethics committee of the British Medical Association, said: "I am thoroughly in sympathy with the twins and their doctors and I think that kind of courage should be applauded."