Experience with treatment of three pairs of conjoined twins.

Three pairs of female conjoined twins--a xiphoomphalopagus, a pygopagus, and a thoracopagus--were encountered during the past 10 years. Surgical separation was successful in the xiphopagus, and both twins survived. Separation was also successful in the pygopagus, but only one of the twins survived; the twin that died had sustained cerebral hemorrhage before the operation. Both of the twins in the thoracopagus died before surgery could be performed, due to sepsis and heart failure, 44 days after birth. Separation surgery of conjoined twins is often successful with a high survival rate of both twins unless vital organs such as the brain or the heart are fused. However, unlike other operations, separation surgery entails ethical considerations pertaining to matters such as the distribution of organs in addition to surgical considerations. Furthermore, separation of conjoined twins is certain to cause various degrees of anatomical as well as functional disorders associated with the surgical procedure, and provision for the postoperative care for these disorders is indispensable.