Conjoined twins in 2020 – state of the art and future directions

Abstract

Purpose of review A number of high profile conjoined twin separations have been extensively covered by the world media. Anaesthesia for conjoined twins is a procedure rarely experienced by paediatric anaesthetists. The increased survival of the twins has prompted discussion as to the most appropriate selection of patients, teams and hospitals to provide exceptional anaesthetic care. Recent findings The number of conjoined twins presenting for surgery remains low with many infants not surviving foetal or early neonatal life. Anaesthetic management of less common conjoined infants such as craniopagus twins has highlighted the benefit of careful patient selection, extensive preoperative investigations and meticulous multidisciplinary team planning. The role of simulation of possible adverse perioperative events has been highlighted. Three dimensional anatomical models and virtual reality systems have permitted surgical planning in advance of actual intervention. A number of legal and ethical concerns have been reported especially in the setting of emergency separation where surgery is likely to contribute to death of one of the twins. Summary There appears to be an expanding role for international teams with extensive separation experience becoming involved in international teleconferencing to improve patient management in low-resource countries. Whether the perioperative outcome is better when the conjoined twins are transferred to major centres for surgery or teams operate in the twin's country of origin remains to be seen.

Conjoined twins in dichorionic diamniotic triplet pregnancy: a report of three cases and literature review

“…Conjoined twins are a rare and serious complication of monochorionic twins. The total incidence is 1.5 per 100,000 births, and about 50% are liveborn [ 1 ]. Conjoined twins are more common in females, and the male-to-female ratio is 1:3 [ 4 ].…”

“…Elective separation is feasible in omphalopagus, pygopagus, and some craniopagus and thoracopagus twins. Separation is not possible in cephalopagus, parapagus, and rachipagus twins [ 1 ]. The difficulty and prognosis of surgical treatment are related to the location and degree of conjoined parts.…”

“…The separation of conjoined twins is complex and expensive, involving multidisciplinary teams. When separation involves the unequal sharing of limbs and organs, or when separation leads to the death of one of the conjoined twins, complex ethical issues will also arise [ 1 ].…”

“…Conjoined twins are a rare and serious complication of monochorionic twins. The total incidence is 1.5 per 100,000 births, and about 50% are liveborn [ 1 ]. The survival rate of conjoined twins is low, and the prognosis is generally poor.…”

Successful Anesthetic Management from Separation Surgery of Pygopagus Conjoined Twin; Lesson-Learning With A Teleanesthesia

“…This disorder requires medical and psychological attention and is an example of medicine's most complex problem-organizing and ethical issues (1). The incidence of conjoined twins is 1.47: 100,000 live births (2). Based on the fusion, both dorsal and ventral, conjoined twins can be divided into eight subtypes: omphalopagus, thoracopagus, cephalopagus, ischiopagus, parapagus, craniopagus, rachipagus and pygopagus.…”