Tendean Michael, Lampus Harsali Fransiscus, Rendy Leo, Wijaya Candy, Panelewen Jimmy
Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi Kandou General Hospital, Manado, Indonesia.
Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi Kandou General Hospital, Manado, Indonesia.
Int J Surg Case Rep. 2023 Sep;110:108613. doi: 10.1016/j.ijscr.2023.108613. Epub 2023 Aug 17.
Conjoined twins are rare, high-stakes cases requiring complex management. This report presents thoraco-omphalopagus conjoined twins who shared parts of liver and abdominal wall. The main obstacle in separating these patients was liver fusion.
Two-year-old female conjoined twins presented with liver fusion between segments 2 and 3 in twin A and segments 2 and 4A in twin B. Liver separation was performed using the modified liver hanging maneuver. After separating the triangular ligaments and surrounding adhesions, a 12-Fr Foley catheter was inserted under the fused liver, suspending it upward and producing a clear separation plane. Liver separation required only 32 min. No notable bleeding or bile leakage was observed.
The liver hanging maneuver was originally used as an adjunct technique for liver tumor hepatectomy. We used this technique to separate the fused livers in conjoined twins. The advantages of LHM include potentially reducing excess manipulation, which may result in parenchyma and vascular pedicle injury, and facilitating bleeding control, thereby reducing the operation time.
The liver hanging maneuver using a conventional Foley catheter is a simple and useful method for separating fused livers in conjoined twins.
联体双胎罕见且风险高，需要复杂的管理。本报告介绍了胸腹联体双胎，她们共享部分肝脏和腹壁。分离这些患者的主要障碍是肝脏融合。
两岁女性联体双胎，A胎肝脏第2段和第3段之间以及B胎肝脏第2段和第4A段之间存在肝脏融合。采用改良肝脏悬吊术进行肝脏分离。分离三角韧带和周围粘连后，在融合肝脏下方插入一根12F Foley导管，将其向上悬吊，形成清晰的分离平面。肝脏分离仅需32分钟。未观察到明显出血或胆漏。
肝脏悬吊术最初用作肝肿瘤肝切除术的辅助技术。我们使用该技术分离联体双胎的融合肝脏。肝脏悬吊术的优点包括可能减少过度操作，过度操作可能导致实质和血管蒂损伤，并有助于控制出血，从而缩短手术时间。
使用传统Foley导管的肝脏悬吊术是分离联体双胎融合肝脏的一种简单且有用的方法。
