How Nigerian Surgeons Separated Twins Joined at Chest and Abdomen: Inside the Landmark Surgery

In a landmark medical achievement in Nigeria, a team of 78 doctors successfully separated conjoined twins, Goodness and Mercy, who were joined at the chest and abdomen.

 

Ejes Gist News reports that the operation, which took place 15 months after their birth, is considered one of the most complex twin separation surgeries undertaken in the country.

 

Born on August 13, 2018, at the Federal Medical Centre, Keffi, Nasarawa State, the twins were immediately referred to the National Hospital, Abuja, after doctors discovered they were conjoined. Their parents, Michael Edeh Martins, a self-employed painter, and Maria Martins, an unemployed housewife, were initially unaware that their children were conjoined despite undergoing prenatal scans.

“The scan showed they were twins but did not reveal they were conjoined,” Maria Martins recalled. She described the pregnancy as unusually heavy, noting that the twins’ movements in the womb were limited, and she experienced significant physical strain. Her faith and repeated dreams urging her to seek spiritual support gave her strength during the complicated caesarean delivery.

Early Challenges and Referral to National Hospital, Abuja

At birth, the twins faced immediate medical challenges, including omphalocele, a condition where the intestines or abdominal organs are outside the body, covered only by a thin membrane. Dr. Emmanuel Ameh, a Consultant Paediatric Surgeon who led the team, explained that addressing this condition was the first critical step in preparing the twins for eventual separation.

“Upon their arrival, our first task was to constitute a multi-disciplinary team comprising paediatric surgeons, cardiothoracic surgeons, neonatologists, cardiologists, imaging experts, anesthesiologists, and specialized nurses,” Dr. Ameh said. The team also included pathologists, physiotherapists, and support staff to ensure every aspect of the twins’ care was meticulously managed.

The National Hospital provided full medical support at no cost, a decision driven by the family’s indigent status and the hospital’s commitment to corporate social responsibility. “From the very day we were referred to the National Hospital, Abuja, they treated us well, no harassment, and we didn’t pay a kobo,” Mr. Michael Martins said.

Preparing for Surgery: Imaging and Tissue Expansion

Before surgery, detailed imaging was conducted to determine which organs and structures the twins shared. It was discovered that Goodness and Mercy had separate hearts but shared a common pericardium, a lower chest wall, diaphragm, and a single liver. Each twin had individual intestines.

 

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The plastic surgery team, led by Dr. Terna Yahweh, inserted tissue expanders under the skin of the twins to ensure there was sufficient coverage for the organs post-separation. The gradual inflation of these expanders over several weeks provided the necessary tissue without increasing intra-abdominal pressure—a critical step for preventing post-operative complications.

The 12-Hour Separation Surgery

The surgery itself, conducted on November 14, 2019, lasted 12 and a half hours and involved a sequence of meticulously planned procedures. According to Dr. Ameh, the separation began with the abdomen, addressing the liver and diaphragm before progressing to the thoracic area.

“The liver, though shared, was sized effectively as two livers. We employed advanced surgical techniques to separate it quickly without significant blood loss,” he explained. The twins’ hearts were separated with caution due to their shared pericardium, and each twin’s circulatory system was carefully monitored by dedicated anesthetic teams.

Dr. Maryrose Osazuwa, who led the anesthesia team, emphasized the complexity of the operation. “Each twin had two anesthesia teams working in shifts, and all equipment and twins were color-coded to prevent any confusion,” she said. Pre-surgery simulations ensured the entire team was prepared for any eventuality.

Post-Operative Care and Recovery

Following the successful surgery, the twins were closely monitored in the neonatal unit, where their intestines, previously exposed due to omphalocele, had already healed within three weeks. The hospital continued to provide comprehensive care, including nutrition management and follow-up procedures to ensure the twins could develop independently.

Dr. Ameh noted that while the primary separation was successful, additional procedures may be necessary in the future. “We still need to do some work on Mercy’s chest wall, and plastic surgeons will repair abdominal scars as the children grow,” he said.

National Recognition and Government Support

The success of the operation drew praise from the Nigerian Minister of Health, Dr. Osagie Ehanire, who described the procedure as a bold venture into advanced surgery and a demonstration of the country’s growing medical expertise. “These twins are beneficiaries of a healthcare system that, even with modest resources, can rise to high-level challenges,” the minister said.

Further support was promised by government officials, including employment for Mrs. Maria Martins in the Federal Civil Service and continued monitoring of the twins’ progress. The National Hospital’s Chief Medical Director, Dr. Jaf Momoh, emphasized that financial constraints would not impede the twins’ ongoing care.

The Human Story Behind the Surgery

For the Martins family, the journey from discovery to separation was one of resilience, faith, and community support. Living in a one-room apartment in Mararaba, FCT, with their first daughter and extended family, the couple faced daunting physical, emotional, and financial challenges.

“Our faith and trust in the medical team were essential,” Maria Martins said. “We prayed for the successful separation and support throughout the process. Today, we are grateful to see our children growing as independent individuals.”

The story of Goodness and Mercy highlights not only medical ingenuity but also the importance of accessible healthcare, compassionate hospital management, and coordinated team efforts in achieving extraordinary outcomes.

Implications for Nigerian Medical Practice

The success of this surgery marks a significant milestone for pediatric and cardiothoracic surgery in Nigeria. Previously, most conjoined twin separations in the country involved abdominal fusion alone. The National Hospital, Abuja, demonstrated that complex chest and abdominal separations are achievable with adequate planning, teamwork, and multidisciplinary coordination.

Key takeaways from the case include:

• Importance of Multi-disciplinary Teams: Combining expertise from multiple specialties ensures comprehensive care.
• Pre-Surgery Planning: Detailed imaging, tissue expansion, and simulations reduce intra-operative risks.
• Post-Operative Care: Ongoing monitoring and follow-up procedures are critical for long-term success.
• Community and Government Support: Financial and social support can be pivotal for families facing complex medical procedures.

The case also serves as a model for curbing medical tourism, showcasing that highly specialized procedures can be safely conducted entirely within Nigeria by competent local teams.

The Road Ahead

While the separation surgery was successful, Goodness and Mercy will continue to receive specialized care, including chest wall reconstruction and scar management. The long-term goal is to ensure that both children achieve full health and normal development.

The family’s story underscores the impact of a functional healthcare system, professional dedication, and societal support in transforming lives. For Goodness and Mercy, the journey from conjoined birth to independent childhood represents not only medical triumph but also the enduring power of faith, perseverance, and expert collaboration.

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Source: Daily Trust