Durban’s miracle twins, Nkosingiphile and Siphiwe, slept through their debut to the big world at Albert Luthuli Hospital on Friday.
With tiny curled hands slightly moving and little chests rising and falling, the five-month-old girls were unconcerned that they were making medical history.
The twins were born at their home in Pongola on October 8 last year, conjoined at the chest and abdomen and were admitted to the hospital’s Neonatal Intensive Care Unit, headed by chief specialist Dr Harshavadan Mackanjee.
The girls were separated in a 13-hour operation last Saturday by a team of 25 specialists including neonatologists, paediatric surgeons, cardio-thoracic surgeons, anaesthetists, plastic surgeons, nursing and theatre staff.
The outcome for conjoined twins is extremely risky, with one or both passing away, but the prediction for the Durban twins is highly positive, with both having survived the long surgery and doing well.
Baby Siphiwe came off life support on Friday morning. Picture: Leon Lestrade
On Friday morning Siphiwe was taken off life support and Mackanjee said Nkosingiphile should soon follow suit.
The mammoth operation was preceded by months of detailed preparation and planning by the specialist team.
Mackanjee said: “When they arrived at the hospital they were a combined weight of 3.4kg and we had to get them to a weight of 10kg to make separation feasible.”
As the gastro-intestinal tracts were separate, it was possible to feed them so that natural growth took place.
And then doctors discovered with delight that the twins did not share a heart, but that their hearts were nestled close together.
“During their stay in the ICU, they were meticulously evaluated with regard to what can and cannot be done to areas that were conjoined. The operation was very high risk and was planned segmentally for each team, working one at a time,” said Mackanjee.
The date was set and planned for a Saturday so the specialists, theatre staff and nursing staff would all be available at the right time and an operating room would be available for the whole day.
Dr Harshavadan Mackanjee with KZN Health MEC Dr Sibongiseni Dhlomo. Picture: Leon Lestrade
Practice runs were done both a week before and a day before the operation.
Once in surgery it was confirmed that the twins’ hearts were separate, but that they shared a liver.
“It is where twins are joined which will determined how difficult it is to separate them and each case has its own unique challenges. This was a very complex operation.
"Their hearts were next to each other, which was a big challenge. Then separating the liver was done inch by inch, as livers bleed a lot, and that took two hours.
“Closing the chest and abdomen also took time. The anaesthetist had to keep the babies under for 14 hours, which is a very long time,” said Mackanjee.
The babies were returned to ICU in a stable condition and the first crucial post-operation 24 hours remained uneventful.
“You could barely see the babies' faces without all the paraphernalia around them,” said Mackanjee, adding that it had been noticed that the babies were missing each other after spending five months face to face, so mirrors had been put in front of their faces as a comfort source.
The twins' mother, Fikile, broke down in tears at the press conference on Friday as she described her relief after the operation.
“When I entered the hospital, I was so unsure and the whole process of the operation was outstanding. I’m so relieved it is all over,” she said.
KZN Health MEC Dr Sibongiseni Dhlomo congratulated the team of specialists and nursing staff in the neonatal ICU unit.
“This is a showcase of what South Africa can do.
"It is a miracle to start with that the babies were kept free of infection for the first five months. There was a lot of detail in the planning of the operation and the day it was done was the cherry on top.
"This would have cost millions in private healthcare and highlights that health should not be a commodity which only some can afford,” said Dhlomo.
The babies are expected to remain in intensive care for the next four weeks.