The stats behind the remarkable separation of two conjoined twin sisters have been revealed. It took around 100 doctors more than 50 hours to separate two-year-old sisters Safa and Marwa Ullah through a series of operations over a five-month period. The surgeries at Great Ormond Street (GOSH), in London, began last October and the twins were finally detached on February 11 this year. Before doctors could even start they had to spend months studying the girls’ brains and used 3D printing to create plastic models of the structures that could be used for practice. They also used VR to create an exact replica of the girls’ anatomy that allowed surgeons to visualize what they were in store for.
The first operation saw them remove three large segments of skull, which they would later reattach between operations as a rigid frame held together by metal mesh and screws. Great Ormond Street Hospital separation of two-year-old conjoined twins Safa and Marwa Ullah
They underwent several operations that took more than 50 hours to complete
Next, the surgeons had to clamp and seal the arteries which carried blood from one twin to the other, before using a soft sheet of medical plastic to keep the once-joined brains separate and prevent them from reconnecting. Tissue expanders – four empty plastic sacs placed underneath the skin which were then filled with saline – were used to stretch the skin before the girls were finally separated. Their partially exposed heads were wrapped in plastic film before they could be safely moved to separate operating theatres for the final stages of the procedure.
In February doctors were finally able to complete reconstruction of their skulls, which involved using the twins’ own bone, fragments of which were ‘jigsawed’ over their heads and then covered with the expanded skin. It wasn’t all plain sailing, with doctors worried at one point they would lose Marwa during an operation after her heart rate fell. As a result of her complications, they gave her a key vein that the twins shared. But this had an impact on Safa, who suffered a stroke less than 12 hours later due to the loss of the vein.
Both of the girls are now doing well and are living at a London address with their mother Zainab Bibi, 34, grandfather Mohammad Sadat Hussain, 57, and uncle, Mohammad Idrees. Their father died of a heart attack while their mother was pregnant with them. Mum-of-nine Ms Bibi, from Charsadda in Pakistan, said: ‘We are indebted to the hospital and to the staff, and we would like to thank them for everything they have done. ‘We are extremely excited about the future.’ Neurosurgeon Noor ul Owase Jeelani and craniofacial surgeon Professor David Dunaway led the team that operated on the girls. Great Ormond Street Hospital has previously successfully separated craniopagus twins – with their skulls and blood vessels fused together like Safa and Marwa – in 2006 and 2011. The twins’ story was followed by the BBC.