Conjoined twins attached at the chest, belly and pelvis are successfully separated in painstaking 15-hour operation

Daily Mail​

13-05-2025

Twin sisters who were born sharing a chest, stomach and pelvis have now been separated in a massive 15-hour operation involving nearly 60 medics.
Kiraz and Aruna, from Brazil, were born conjoined and shared several vital organs, making their surgical separation an incredibly complex procedure.
The one year-old sisters went under the knife on May 10th in what one of the surgeons involved said was one of the most complex ever performed in the state of Goiás where they live.
The girls are what is medically known as tripus ischiopagus conjoined twins. This means the pair were joined at the pelvis and have three legs between them.
Tripus ischiopagus is rare even among conjoined twins, accounting for only about six per cent of all cases.
The sisters are still recovering in the intensive care unit of a children's hospital but are reported to be in a stable condition.
Hospital officials said a team of 16 surgeons worked in four-hour shifts to complete the mammoth operation as quickly possible to reduce the risk of potentially serious complications.
Lead surgeon Dr Zacharias Calil explained: 'There are around 16 surgeons involved, including four anaesthetists, residents, three urologists, paediatricians and orthopaedists.'
He also told local media: 'This will be one of the most complex procedures we have ever performed.'
However, the twins still face a series of follow-up procedures needed to reconstruct the tissue and organs impacted by the separation.
The £310,000 operation itself represented months of preparation.
Six months before going under the knife Kiraz and Aruna had skin expanders, special inflatable implants, inserted into their bodies.
These implants cause skin surrounding the area to stretch and grow and will help surgeons reconstruct tissue for the twins in subsequent operations.
Cases of conjoined twins are incredibly rare, occurring in as few as one in every 200,000 births, according to some estimates.
Despite recent medical advances surgery to separate conjoined twins is still considered a delicate and risky procedure requiring extreme precision and care.
Mortality rates for twins who undergo surgical separation vary tremendously depending on the exact nature of their connection and which organs they share.
Since the 1950s at least one twin has survived the surgery 75 per cent of time.
Therefore, the decision to separate twins is a serious one.
Normally, twins are born after a single fertilised egg splits and develops into two individual embryos.
The split normally occurs eight to 12 days after conception with the embryos going on to develop their own tissues and organs separately.
However, in the case of conjoined twins it is believed this split happens too late and the embryos do not separate.
Approximately 40 to 60 per cent of conjoined twins arrive stillborn, while around 35 per cent survive only one day.
About one set of conjoined twins is born in the UK per 500,000 births, which translates to about one per year on average.