04/10/2001

Associated Press

SINGAPORE – Eleven-month-old twins Jamuna and Ganga Shrestha were in different rooms for the first time in their lives today after doctors successfully separated the girls, who were born joined at the head.

A wide-eyed Jamuna – the more bashful sister – was wheeled out of the operating room wearing a tiny surgical cap early Tuesday after the grueling marathon surgery doctors are calling a success.

The feistier sister, Ganga, finally left the operating room at Singapore General Hospital at 4 p.m. – 96 hours after entering. Dr. Keith Goh, who lead the medical team, said Ganga's operation took longer because she needed more "complex reconstruction."

The Nepalese twins shared the same skull cavity. Their brains were partially fused, making the separation surgery extremely difficult.

"Happily, we had no adverse events throughout the entire five days" of surgery, Goh told reporters at a news conference after the surgery. "We are cautiously optimistic."

Goh said it was too early to tell if the twins would suffer brain damage or other neurological defects, and that the next few days would be crucial for the girls.

"Thank God, now I will be able to see my great-grandchildren and I hope they come back soon," Devkumari Khatri, 84-year-old great-grandmother of the twins, told The Associated Press in Nepal by telephone.

Surgeons began operating on the twins at 4:00 p.m. Friday, initially hoping to finish within 40 hours. Twenty doctors worked in shifts around the clock to separate the girls. Anesthesiologist Claire Ang said the mood in the operating room "varied from euphoric to hysterical."

To close the wound left by the surgery, doctors used the synthetic material Gortex to replace parts of the girls' dura, a fibrous tissue layer covering the brain. They mixed bone material with polymer to help rebuild the girls' tiny skulls.

Goh and other members of the medical team said the surgery took so long because they had to deal with hundreds of interwoven blood vessels in the girls' brains.

Siamese twins joined at the head are very rare, occurring once in 2 million live births, according to Goh. Successful separations are even more uncommon.

Surgeons in Brisbane, Australia, last year successfully separated six-month-old Tay-lah and Monique Armstrong, who were joined at the backs of their heads. A similar operation was successfully performed in South Africa in 1997.

Ganga and Jamuna, the twins in the Singapore surgery, are the only children of a poor couple from the remote Nepalese mountain village of Khalanga, where Maoist guerrillas are active.

The girls' mother, Sandhya, is a kindergarten teacher and their father, Bushan, helps his father in a small business. The couple, who are in their 20s, kept almost constant vigil at the hospital during the operation with brief breaks to pray at a Hindu temple.

A surgeon in Nepal referred the family to doctors in Singapore, a wealthy Southeast Asian city-state known for its advanced medical facilities.

Before the surgery, doctors rehearsed the procedure in virtual reality using a three-dimensional imaging system developed in Singapore.

The system, called VizDExter, was first used in 1998 by doctors at Johns Hopkins University in Baltimore, said Dr. Luis Serra, a Singapore-based researcher who helped develop the technology.

Serra said the doctors used the images to consult with a Johns Hopkins' Siamese twins expert, Dr. Benjamin Carson, before separating Ganga and Jamuna.

Doctors "will have a reasonable idea of the success of the operation within 48 hours of its conclusion," Carson said in a statement.

The greatest risks the twins face after "such a prolonged surgery" are infection and hydrocephalus, Carson said. He added, however, that using a single long procedure will probably work in the twins' favor by making multiple operations unnecessary.

Singaporeans have donated $358,000 to help the twins. The hospital has waived many of their charges, and national flag carrier Singapore Airlines paid for the girls and their family to make the trip from Nepal.

Goh said the girls would likely return to Nepal when they are well enough to travel, which could take months.

In Nepal, relatives had been waiting around the one phone shared by their neighborhood for news on the twins.

"We had only 50 percent hope that they would survive," Abhaya Shrestha, the twins' uncle, said. "Now this is a miracle and we just can't describe how happy we all are to hear the news."