Successful separation of xiphoomphalopagus twins.

A pair of female xiphoomphalopagus twins were delivered by Caesarean section at 35th week of gestation on March 2, 1982, their combined weight being 4,800 g. Examinations revealed that they were conjoined from the xiphoid process down to the umbilicus. Infant A also had congenital heart defect (VSD). X-ray and echography showed that they had a fused liver and two independent biliary systems and alimentary tracts. After 6 weeks, the twins gained weight up to 7,000 g. The separation operation was performed at 1 1/2 months of age. During operation it was demonstrated that the xiphoid process and costal cartilages were fused together and the peritoneal cavities were of free communication above the umbilicus, and the livers merged into a single common liver. The large single liver was divided by electrocautery, resulting in a section surface of 8 X 7.5 cm. After separation, the closure of the abdominal wall in both infants presented some difficulties which were resolved by making relaxation incisions on either flanks. In the post operative period, the ventral wounds of both infants were disrupted for several centimetres and infant B had wound infection. The granulating area of skin defect on either relaxation incision of the flanks and ventral denuded wound were covered with full-thickness dead-foetus homografts. The wounds were well healed. Eventually both infants were discharged in good condition at 2 1/2 months after operation. Now they live well at 2 1/2 years of age.