Perioperative management of conjoined twins

Abstract

Successful intraoperative management of conjoined twins undergoing surgical exploration or separation requires timing, teamwork, an appreciation of risks involved, and a firm understanding of conjoined pathophysiology. Prenatal diagnosis of conjoined twins is now possible, and permits careful planning for delivery, for preoperative work-up if separation is possible, and for early mobilization of a multidisciplinary separation team. Delayed separation for weeks or months will allow the needed time for growth, thorough preoperative evaluation of extent of joining, procedural planning sessions, and separation rehearsals. Urgent operations or separations may be necessary in conjoined twins. In these situations, rapid preoperative evaluation and management can be provided by precise nonivasive studies and cardiopulmonary stabilization before transport to the operating room.