Four decades of conjoined twins at Red Cross Children's Hospital-lessons learned

Abstract

Conjoined twins represent a rare but fascinating congenital condition, the   aetiology of which remains obscure. Over the past four decades, the   paediatric surgeons at Red Cross Children's Hospital have been involved in  the management of 4;6 pairs of conjoined twins, of which 33 have been  symmetrical and 12 asymmetrical. Seventeen symmetrical twins have  undergone separation with 22 children (65%) surviving; all of the live  asymmetrical twins survived separation. We describe the important features of  this unique cohort, outline our approach to management and present the results of this approach. We consider some of the ethfcal and  moral  dilemmas we have confronted, and discuss the prenatal diagnosis, obstetric  implications and postnatal care of these children, including the relevant  investigations and anaesthetic and surgical management. Specific aspects  related to the cardiovascular system, hepatobiliary and gastrointestinal tracts,  urogenital tract, central nervous system and musculoskeletal system are  highlighted.