Siamese twins separated in one of the most complex and advanced operations ever attempted in the Republic of China were pronounced as out of danger and doing well 20 days after surgery. Seemingly inextricably joined at the abdomen, the twins were separated in a 12-hour operation Sept. 10 which captured the attention of the whole nation. Headlines in the newspapers tell their own story: "Doctors keeping close tabs on twins after long ordeal," "One twin shows fast heartbeat after separation," "Twins in good condition; survival chance high," "Condition of twins continue to improve," "Twins doing fine," "Twins may move out of intensive care unit," "Our twins start eating congee," "President hosts party for medical squad," "Separated twin asks where the other leg is," "Twins get psychotherapy," "Twins recovery different from each other." Readers were thus able to share in the drama during the operation and the joy as the twins improved day by day. In order to allow people islandwide to have the most up-to-date news on the twins, Hung Chi-jen, director of the surgical department of the National Taiwan University Hospital, where the operation was performed, issued regular bulletins on television during the critical first week after the operation. Included in the reports were details of body temperatures, blood pressure, respiration and heartbeats.
Soon after the twins' birth on Dec. 23, 1976, they were sent to the Chungshan School of Medicine at Taichung. On June 18, after they were taken to the NTU Hospital for observation, doctors decided to perform the separation operation.
Chang Chung-jen and Chang Chung-yi are only the 13th Siamese twins ever to be born joined at the ischium. Of three previously attempted operations, one was successful, one failed, and only one twin survived in the third.
The operation, unprecedented in Asia, began at 7:30 a.m. when the twins were anesthetized by Chao Chi-ching, who has performed the service for more than 50,000 patients. Before the operation, the twins faced each other, sharing three legs, one of which was deformed, and one set of genitals. They now each have a bladder, a leg, half of the large intestine, a liver, and a spleen, and can exist as two humans. Chung-yi has two kidneys and two ureters, while Chung-jen has only one of each.
The operation was conducted in four three-hour stages by four shifts of doctors.
In the first stage of the operation, surgeons and pediatrists cut open the shared abdomen and separated the skin and the intestines of the twins at 8:30 a.m. A second team took over the surgical table and began to adjust the urinary system. In the third stage, doctors gave Chung-yi an anus, rectum, and a urethra and gave each twin a testicle each. The pubis was separated at 2:55 p.m. and the third leg was removed before the pelvis was split in two. At 5:15 p.m., the twins started to live and grow separately. The fourth phase went smoothly as the cuts were stitched, skin was pulled over the open wounds and artificial anuses were installed. The operation ended at 8:30 p.m.
Several nurses who had taken care of the twins for a long time broke into tears when the operation was finished. One of them said: "I don't know at this moment if I'm happy or sad about Chung-jen and Chung-yi. Maybe I have both feelings: happy that the operation is over and they are safe; sad over the long struggle they have ahead with only a half share of some vital organs."
The twin's father, Chang Yi-sheng, a 29-year-old Kaohsiung construction worker, stayed awake all through the long operation. He said he was happy that the operation was successful, but could not predict what the future held for his two sons. He said the will live in Taipei in future so he can visit them often. Millions of people watched the live television broadcast of the operation. Donations and expressions of concern have been pouring in as news of the twins' predicament spread.
Eight days after they were separated, the twins were wheeled out of the intensive care unit back to their old ward as their conditions improved. The doctors removed all the monitors on their body and fed them with rice porridge. Doctors later took out the last stitches on sutures from the upper abdomen of Chang Chung-yi as his condition continued to improve. But his twin brother, Chang Chung-jen had a rupture at the suture 15 days after they were separated. The incident is not expected to endanger Chung-jen's life, however. After the removal of his sutures, Chung-yi was able to sit up alone for the first time in his life.
Psychologists and rehabilitation doctors are now trying to establish friendship with the separated Siamese twins so as to assist them to achieve a physical as well as mental balance. Emphasis will be placed on reducing the traumatic effects of the operation, physiotherapy to train them to use their remaining limbs.
On Sept. 12, President Chiang Ching-kuo hosted a tea party at the Presidential Office to extend his congratulations to the 36-member medical squad which conducted the surgery. The President encouraged the doctors to write a book describing the operation and its significance. Five days later, the President received them again in his office to show his concern over the rehabilitation problems of the twins and congratulate all the workers and nurses who contributed their time and efforts before and after the separation.
The triumph has brought new prestige to the Chinese medical profession in general, and doctors at the National Taiwan University Hospital in particular.
Separated Twins Winning Struggle for Survival.
Separated Twins Winning Struggle for Survival.
