New Delhi: “It is such a great coincidence that Jagga and Balia will reach home on 7th September and Chandrayaan II will also touch the moon on the same date. It’s not only India’s scientists that are doing India proud, it is the commendable determination and commitment of the doctors also that is making India proud. This rarest of the rare surgery is one such shining example. It can be called “AIIMS Delhi Jagga and Balia craniopagus surgery”. This was stated by Dr. Harsh Vardhan, Union Minister of Health and Family Welfare and President AIIMS, New Delhi as he interacted with the media, here today, on the day when the two twin brothers prepare to leave for their home in Odisha after a successful surgery to separate them at AIIMS, New Delhi. Dr. (Prof.) Randeep Guleria, Director, AIIMS, New Delhi; Dr. (Prof.) S.S. Kale, HoD, Department of Neurosurgery; Dr. (Prof.) Deepak Gupta, Professor of Neurosurgery and head of the team; Dr (Prof) Sheffali Gulati, Department of Pediatrics-Neurology along with other experts who were part of the team of 125 doctors and support team, were also present.
Applauding this rare feat, Dr Harsh Vardhan stated that the doctors of AIIMS have demonstrated extraordinary talent, expertise, determination and compassion in achieving it. This is the result of meticulous planning and precision of thinking. “This is the first successful craniopagus conjoined twin separation surgery from India wherein both the children have survived,” he said. He further added that worldwide only 10-15 children have survived after surgical separation of this condition in the last 50 years. This is an extremely rare condition seen in 1 in 25 lakh live births and any kind of surgical intervention in this condition is associated with 75-80% risk of life to one or both children. “All modern adjuncts of technology for surgical planning, 3D print model technology for brain and skull model development, venous bypass, staged surgeries and continuous postoperative care was provided by the craniopagus team of over 75 doctors and 50 nursing /support team staff at AIIMS, Dr Harsh Vardhan said.
The Health Minister stated that it is a subject matter of scientific research to examine that two children from the tribal belt of Odisha were able to withstand such complicated surgery. He added that such a rare case, and the fact that the twins survived the extensive complicated surgery presents an equally rare opportunity to study the various medical and other facets of this unique case and derive valuable learnings for further medical reference and knowledge.
Dr Harsh Vardhan further stated that this case also amply depicts that India is competent to perform such surgeries, and also that poor people from tribal regions from where the twin brother hail from, can also get the best of medical care. A similar surgery in the US in 2016 cost Rs. 2.5 million USD (approx. Rs. 17 crore).
Dr Deepak Gupta, Professor of Neurosurgery made a detailed presentation on the history of the case. Outlining the various stages from the date the twins were admitted to the Department of Neurosurgery (AIIMS, Delhi) on 14th July 2017, he stated that detailed planning for surgical separation was carried out on these conjoined twins totally fused to each other at head level (Craniopagus twins) by a team of 125 doctors and support team led by him. He emphasized on the importance of ‘Planning, Practice and Perform’, along with team work.
The first stage surgery, lasting 25 hours, involved creating a venous bypass on Balia and partial brain separation from Jagga, and was conducted on 28th August 2017. The final separation of the two children was successfully done on 25th October 2017 in an operation which lasted for 20 hrs. Skin grafting and minor neurosurgical procedures were done for the twins to cover skin defects by the plastic surgery team over next few months.
The AIIMS doctors briefed that the Jagga-Balia case was highly complex as they shared venous return (circular sinus) and were totally fused to each other at the head level (Total Vertical type 3 with fused brains in parietal and occipital lobes). They were born in Kandhamal District of Odisha and were kept in SCB medical college, Cuttack for the initial three months after birth. A detailed discussion was held with their family prior to the surgery on the risks associated with the procedure. The doctors informed that while Jagga is developing well in all the domains on neuropsychological assessment and can join special school in Odisha immediately after going to his home state, Balia remains neurologically disabled with profound intellectual impairment. He requires long-term rehabilitation care and needs nurturing and tender loving care as assessed by the neuropsychologists.
A team of three doctors (Dr Deepak Gupta, Neurosurgeon; Dr Girija Rath, Neuroanesthetist; and Dr Kiran Kumar, Pediatrician) along with one nurse from AIIMS, Delhi will accompany the two children on their way back to Odisha by rail today. The two children will be initially kept in SCB Medical College Cuttack for a few weeks for rehabilitation and supportive care. The Odisha government has provided continuous support to these two children right from the time of their admission to AIIMS, New Delhi and continue to do so.
The administration at AIIMS has been proactive in supporting the doctors and other healthcare personnel throughout the treatment of these twins. The administration provided logistic support to the treating team and ensured that the official process was fast-tracked.