title: 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 46 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 ethical 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.
authors.affiliation: Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa. rode@ich.uct.ac.za
authors.forename: H
authors.initials: H
authors.lastname: Rode
authors.forename: A G
authors.initials: AG
authors.lastname: Fieggen
authors.forename: R A
authors.initials: RA
authors.lastname: Brown
authors.forename: S
authors.initials: S
authors.lastname: Cywes
authors.forename: M R Q
authors.initials: MR
authors.lastname: Davies
authors.forename: J P
authors.initials: JP
authors.lastname: Hewitson
authors.forename: E B
authors.initials: EB
authors.lastname: Hoffman
authors.forename: L D
authors.initials: LD
authors.lastname: Jee
authors.forename: J
authors.initials: J
authors.lastname: Lawrenson
authors.forename: M D
authors.initials: MD
authors.lastname: Mann
authors.forename: L S
authors.initials: LS
authors.lastname: Matthews
authors.forename: A J W
authors.initials: AJ
authors.lastname: Millar
authors.forename: A
authors.initials: A
authors.lastname: Numanoglu
authors.forename: J C
authors.initials: JC
authors.lastname: Peter
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.forename: H
authors.initials: H
authors.lastname: Wainwright
mesh_terms: D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D004200:Diseases in Twins / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006766:Hospitals, County / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014428:Twins, Conjoined