Twin dies, other critical

A pioneering operation to split Siamese twins joined at the head ended in tragedy today when one died soon after doctors announced they had been separated.

The 29-year-old sisters Ladan and Laleh Bijani, suffered massive blood loss as neurosurgeons finished separating their brains "millimetre by millimetre".

But minutes after the three-day procedure was completed they reported that Ladan, the more extrovert of the twins, had died.

Staff at Singapore's Raffles Hospital, where the surgery was performed, had initially been hopeful both would survive, with one doctor calling on people to "pray very hard" for the Iranian-born women.

Before embarking on the surgery, they were warned they faced only a 50-50 chance of survival - yet they said they were willing to risk death for the chance to lead separate lives.

In 1996 doctors in Germany rejected their request for surgery, saying splitting them could prove fatal. But the Bijanis were determined to go ahead and persuaded Singapore doctors to operate despite the risks.

Moments after the procedure was completed a spokesman for the Raffles Hospital, Dr Prem Kumar Nair, said: "Laleh and Ladan were separated a short while ago. However they lost a lot of blood and are in a critical stage."

Dr Nair said Ladan was in a more critical condition than Laleh. Then came the news that Ladan had died on the operating table. Surgeons are now battling to stabilise her sister. "We should pray very hard for them," added Dr Nair.

Unforeseen complications in cutting through the twins' tightlyknit skulls had added about 17 hours to the operating time, originally estimated at 48 hours.

However doctors overcame their first hurdle, successfully rerouting a shared vein that drains blood from the twins' brains.

Speaking at a press conference earlier today, Dr Nair said: "In the process of separating, you cannot just tear them apart.

"They have to be teased apart very slowly, cut, teased apart, cut, teased apart. Although the brains are distinctly separate, because they have been fused for the last 29 years they are very adherent to each other. The neurosurgeons have to cut through the brains very carefully, literally millimetre by millimetre.

"In the process we have encountered a lot of blood vessels and a lot of tissue that is taking a long time to separate."

Dr Nair said doctors had completed a key part of the operation, using a vein extracted from Ladan's right thigh to replace for her a shared major vein that drained blood from the brains. But after the bypass, blood circulation between the twins became unstable.

Twins joined at the head occur only once in every two million live births. Successful separation is very rare.