Conjoined baby twins, whose spinal cords were fused, have been successfully separated in pioneering surgery in Birmingham.
The girls, Eman and Sanchia Mowatt, who are now three months old, were yesterday said to be doing well in intensive care at the Birmingham Children's Hospital on their third day apart.
Their case was unusual. About 75% of conjoined twins are face to face, and where twins are joined back to back, it is generally the bones that are fused.
The first operation of its kind in the UK and perhaps the third in the world lasted for 15 hours as teams of surgeons and anaesthetists apportioned the spinal cord and separated the bladders, rectums and reproductive organs.
The future looks good, although it is not certain they will be able to walk normally. "They both have one normal good leg and one that is weak below the knee. That remains the same," said Tony Hockley, one of the neurosurgeons, who successfully cut apart the spinal cords that were fused at their base.
"I hope they will be able to walk. We see a lot of spina bifida babies, this was a bit like two such babies being stuck together. A lot of those do walk when the problem is the base of the spine."
The girls' parents, David and Emma Mowatt, said they had both been deeply shocked and traumatised when they were told, after a routine 20-week scan, that the twins were conjoined. Yesterday they said they were elated by the success of the operation.
"I was actually able to hold them without holding them together," said Mrs Mowatt, 27, a bank worker. "When the nurse handed them to me this morning, I picked up Sanchia and then Eman, and held both of them."
For 10 weeks while they were waiting for the operation the babies had been at home. It had been strange, she said, "knowing that if one was crying, we would still have to pick the other one up, who was fast asleep in spite of the other baby crying".
The babies used to hide their heads behind each other, but were already developing separate personalities, she said. "For instance, if they are hungry, I would say Eman is louder than Sanchia. She cries when she wants something to eat. Sanchia usually waves her hands about or pulls her hair when she is hungry. Sanchia is more reserved than Eman. Eman is more outspoken."
The couple decided to continue with the pregnancy after the scan and the babies were born at Birmingham's City Hospital by caesarean section. They were transferred immediately to the Children's Hospital because one of the twins was born without an anus, and needed immediate surgery.
Later, plastic surgeons "grew" extra skin to cover the base of their spines once they were separated; a silicone balloon was placed underneath their existing skin and gradually expanded with fluid over six weeks. Then the babies went home to await separation.
Mr Hockley and a neurosurgical colleague began the operation by separating the spinal cords, which was not simple. "There was no plane of cleavage," he said. "The two came together and fused as one. There was also a degree of rotation. We had to make our cut so that each baby girl got her spinal cord back, and make a tube to cover it. The technique of cutting is conventional but it is knowing where to cut. We had nerve stimulators to help."
The cords were separated without additional damage to either baby. Then the paediatric surgeon, Peter Gornall, with one of the world's leading experts on conjoined twins, Lewis Spitz, from Great Ormond Street, who had been involved from the start, worked to separate the organs such as the bladder which were complete but stuck together.
The twins may have other problems because the nerves that supply bladder and bowel control were contained in the damaged section of the spinal cord. "But we can deal with that," said Mr Hockley.
