Complications are common and may include the following:
Congestive cardiac failure: This is observed when a conjoined heart is divided.
Inadequate or incomplete organ systems: This complication occurs when the twins have unequal distribution of their organs (eg, one shared biliary tract). Adequate preplanning in these cases is essential.
Enormous skin defect: This may result following separation of a large bridge and can often be avoided by delaying the surgery until age 1 year. Preseparation tissue expanders may be useful to avoid this problem. The expanders are essentially pouches, which are gradually filled with saline solution. This stretches the skin, allowing the surgeons to close the wounds after separation surgery.
Infection: Strict infectious precautions are required for 2 days following the surgical procedure, and patients are kept in the ICU. If they do well, routine precautions are adequate for follow-up care.
Hemorrhage: Life-threatening exsanguination can result, especially in craniopagus twins who have a large communicating venous sinus.
Several factors may predict or influence outcome, including the following:
Prenatal MRI and ECG: These techniques can be performed to accurately define the conjoined anatomy, and an outcome can be predicted. However, the echocardiogram can underestimate the complexity of the cardiac anatomy. Currently, 9 weeks is the earliest gestational age at which conjoined twins have been detected. However, false-positive cases are common before 10-11 weeks, as the fetal movements are limited. Monoamniotic twins may appear conjoined.
Congestive cardiac failure: This is observed when a conjoined heart is divided.
Inadequate or incomplete organ systems: This complication occurs when the twins have unequal distribution of their organs (eg, one shared biliary tract). Adequate preplanning in these cases is essential.
Enormous skin defect: This may result following separation of a large bridge and can often be avoided by delaying the surgery until age 1 year. Preseparation tissue expanders may be useful to avoid this problem. The expanders are essentially pouches, which are gradually filled with saline solution. This stretches the skin, allowing the surgeons to close the wounds after separation surgery.
Infection: Strict infectious precautions are required for 2 days following the surgical procedure, and patients are kept in the ICU. If they do well, routine precautions are adequate for follow-up care.
Hemorrhage: Life-threatening exsanguination can result, especially in craniopagus twins who have a large communicating venous sinus.
Several factors may predict or influence outcome, including the following:
Prenatal MRI and ECG: These techniques can be performed to accurately define the conjoined anatomy, and an outcome can be predicted. However, the echocardiogram can underestimate the complexity of the cardiac anatomy. Currently, 9 weeks is the earliest gestational age at which conjoined twins have been detected. However, false-positive cases are common before 10-11 weeks, as the fetal movements are limited. Monoamniotic twins may appear conjoined.
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