Experience in the management of conjoined twins.
BACKGROUND
Conjoined twins occur in approximately one in 200 000 live births. Their management is often extremely complex and experience with large numbers is restricted to a few centres worldwide.


METHODS
An analysis of 17 sets of symmetrical conjoined twins managed by a single team of surgeons over a 16-year period was undertaken.


RESULTS
Management could be divided into three groups. Those in group 1 (n = 5) had non-operative management, owing to cardiac fusion or gross anatomical union, and all died. Those in group 2 (n = 7) underwent emergency separation, when one twin was dead or threatening the survival of the sibling or where there was a correctable life-threatening associated anomaly (four of 14 survived). Twins in group 3 (n = 5) underwent elective separation, allowing time for detailed preoperative investigation and planning (eight of ten survived).


CONCLUSIONS
Accurate preoperative investigation, a team approach, previous experience, and meticulous operative and postoperative management contributed to the success rate achieved in this series.
Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK. L.Spitz@ich.acl.ac.uk
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Kiely
D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D016019:Survival Analysis; D014428:Twins, Conjoined / Q000601:surgery*