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The Sultanate of Oman achieved a new medical milestone by successfully performing the first separation surgery for conjoined twins of the "Omphaloischiopagus" type. This rare form of conjoined twins share the pelvic area, with connections in the intestines, urinary system, and blood vessels.
The surgery was conducted under the direct supervision of Dr. Hilal Ali Al Sabti, Minister of Health. The medical team included several specialists from various fields, along with a select group of surgeons and medical teams from the Royal Hospital, Khoula Hospital, the Medical City Hospital for Military and Security Services and Nizwa Hospital. The team coordinated under a comprehensive medical plan to ensure the best possible outcomes.
The twins are currently receiving intensive care in the ICU, with their health condition steadily improving.
This surgery marks the first of its kind in the Sultanate of Oman, requiring a comprehensive medical effort involving specialized Omani teams from various surgical and supportive medical fields. This achievement reflects the progress and advancement of healthcare services in the country.
The surgical procedure went through several critical stages, beginning with a thorough assessment and multi-stage surgical preparation. This was followed by the separation surgery and tissue reconstruction, and ultimately the post-surgery phase, which requires intensive medical care to ensure the recovery and health stabilization of the twins.
Dr. Mohammed Jaafar Al Sajwani, Senior Consultant Pediatric Surgeon at the Royal Hospital and head of the medical team in the separation surgery of the conjoined twins, stated: "Conjoined twins are an extremely rare condition. Unfortunately, many children do not survive before birth, during birth, or after birth, mainly due to the congenital abnormalities they have. While there are various cases of conjoinment, those involving the pelvic area are very rare, especially among girls, which complicates the situation due to the presence of numerous organs in this complex area”.
He added, "We followed up on the case during pregnancy, with communication between us and the obstetricians. We decided to perform the surgery here in Oman and take over their treatment. Thankfully, the birth occurred smoothly, and they were transferred to the neonatal intensive care unit. While we faced some challenges, we were able to overcome them. Over the 11 months of preparation, meetings, and imaging, we identified the location of the conjoinment and the shared organs between the twins. It is clear that the expertise and specialties available in Oman greatly contributed to the success of our preparation."
On his turn, Dr. Muhannad Mohammed Batal, Consultant Pediatric Surgeon, highlighted the significance of this medical success in Oman's healthcare sector, emphasizing the ability of Omani professionals to perform even the most complex surgeries. It further strengthens the Sultanate of Oman's position in the field of advanced surgeries.
Dr. Ali Al Jabri, Senior Consultant in Neonatal Intensive Care and Head of the Neonatal ICU, also shared his insights, stating: "The condition was discovered early by obstetricians, and coordination was made with the intensive care team to ensure a safe delivery, which was carried out via a cesarean section. The efforts culminated in a well-organized institutional plan that took almost a year. It began with daily monitoring of the twins’ condition, which was complicated, and continued with detailed planning involving surgeons, anesthetists, plastic surgeons, and radiologists."
Further, Dr. Nawal Al Sharjiya, Consultant Pediatric Urologist, pointed out that in conjoined twins, especially those conjoined at the pelvic area, there are often complications in the urinary system. One of the main challenges during the surgery was the shared ureters.
Meanwhile, Dr. Masoud Al Abdali, Consultant Pediatric Orthopedic Surgeon at Khoula Hospital, said: "I was entrusted with forming the pediatric orthopedic surgical team, which was made up of specialists in various aspects of pediatric orthopedic surgery, including spine surgery and pelvic surgery from different hospitals. We held numerous preparatory meetings to discuss the details, both within our team and with other specialties, to prepare for this operation. Our role as pediatric orthopedic surgeons in the separation of the twins in the pelvic area involved performing pelvic cuts to bring the lower limbs closer together."
He added: "It was a fascinating experience, and I thank H.E. the Minister of Health for placing his trust in the medical team. I also appreciate the cooperation of the Royal Hospital and Khoula Hospital, which led to the success of the surgery."
Speaking about this operation, Dr. Shaykhan Al Hashemi, Consultant Pediatric Reconstructive and Cosmetic Surgeon at Khoula Hospital, indicated that conjoined twins are an extremely rare condition globally, and this specific case of pelvic conjoinment is one of the rarest. It requires early preparation. The primary benefit of separating conjoined twins is the careful preparation of the tissues, ensuring that each child is able to preserve vital tissues, nerves, and major arteries.
Dr. Ramla Malallah Al Qassab, Senior Consultant of Anesthesiology and Intensive Care, and Head of the Anesthesia Team for the separation surgery, stated: "Anesthesia is one of the most critical stages in any surgical procedure to ensure its success. Preparation began as soon as the decision was made to perform the surgery at the Royal Hospital. We started forming the anesthesia team with great care, including anesthesiologists, technicians, and anesthesia nurses. We also reviewed all anesthesia protocols for such surgeries, especially since this was the first time of its kind in the Sultanate of Oman.”
Furthermore, Dr. Farhana Al Othmaniya, Consultant Pediatric Intensive Care Physician at the Royal Hospital, stated that the surgery was extremely long, lasting nearly 19 hours. Such long surgeries can lead to complications and infections, but the team handled the case with distinction.
Said Al Muslahi, the father of the now-separated conjoined twins, expressed his gratitude to His Majesty Sultan Haitham bin Tarik. He also lauded the professionalism of the medical team and all those who contributed to the success of this operation.
Ruqayah Al Jardaniya, Nurse and Operating Room Supervisor, stated: "We held numerous meetings and preparations to arrange the necessary requirements for the surgery. Coordination was made with other teams, including those from Khoula Hospital, who provided us with support in terms of staff and resources needed for the surgery, all the way until the separation of the twins was successfully completed."
It is worth noting that the occurrence of conjoined twins globally is estimated to be one case for every 200,000 to 1,000,000 births. Meanwhile, the "Omphaloischiopagus" type is one of the rarest recorded cases, making this Omani medical achievement an exceptional accomplishment.
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