Conjoined twins are perhaps the most complex pediatric surgical patients. Because they are also rare, it is also likely that a single pediatric surgeon will take care of very few of them or none at all. Therefore, extensive study of the literature and understanding of patient anatomy and embryology is essential to providing a good outcome. Care of these infants can be both the highlight and greatest challenges of one’s career.
This topic will provide an overview of conjoined twins and provide the basics of understanding for each type. This single reference, however, will not provide the knowledge needed when taking care of these children as each set is unique - as are the challenges that are likely to be encountered during attempted separation. Consultation with others who have previously cared for such infants, case reports and references is invaluable. Well over 1000 cases have been described in the literature. Most through 2003 were cataloged in Spencer’s comprehensive text Conjoined Twins, Developmental Malformations and Clinical Implications . Since then, numerous additional articles describing individual cases have been reported.
It is important to understand that the desire to separate conjoined twins varies significantly by culture and certain ethical standards. While western society places a greater emphasis on the needs of the individual, this is not the case in some areas of the world as highlighted in the book, One of Us . In some cases, ethics, cultural norms and the need for subsequent care may dictate that the twins not be separated. In some instances, it is probable that the need for subsequent care will be less in a nonseparated set than in those undergoing separation. These are all factors that the surgeon and other health care providers need to consider.
It is also crucial to consider that separation is a team effort. While in the past a single surgeon may have taken on these cases and dealt with both babies, the complexities of union and the specifics of separation call for expertise in a number of areas including general, thoracic, cardiac, orthopedic, urologic, neurosurgical and plastic surgery. Careful coordination of services in neonatology, radiology and even media control are essential to providing care for these infants. One person needs to be the lead surgeon and coordinate all of the facets of care that come into play.
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