Conjoined twins in the Philippines: experience of a single institution

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Abstract
We describe our experience with 22 conjoined twins managed from 1974 to 2006. Records of 22 conjoined twins admitted from 1974 to 2006 were reviewed. Interviews with attending physicians were also conducted. There were 11 thoracopagus, 5 omphalopagus, 3 ischiopagus, 2 craniopagus, and 1 pygopagus twins. Five thoracopagus twins were deemed inseparable due to severe cardiac anomalies. One ischiopagus refused separation, and one craniopagus was separated elsewhere. Six twins (three omphalopagus, one each of pygopagus, ischiopagus, and thoracopagus) were separated emergently as neonates; only one twin is a long-term survivor. Mortalities were due to intractable acidosis, sepsis, and hemorrhage. Nine twins (one craniopagus, one ischiopagus, two omphalopagus, five thoracopagus) were electively separated between 9 months and 2 years of age. One set of these thoracopagus twins died of respiratory failure and sepsis post-operatively. A hydrocephalic twin in another thoracopagus twin died intraoperatively. The rest are alive and well. Emergency separations yielded dismal results due to poor patient conditions; delay in separation allowed progressive deterioration and resultant poor outcome. Elective separation had more favorable results due to well-planned strategies, team preparedness, and better patient conditions. A multi-disciplinary approach, with parental participation, is integral in the holistic management of conjoined twins.