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Key Points

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  1. There are 8 primary types of conjoined twins. There is a wide variation in anatomy even between these 8 types.

  2. Prenatal ultrasound and MRI are useful diagnostic tools. The information gained may help when counseling the family and informing the surgical team in case emergency surgery is needed.

  3. Postnatal evaluation depends on the type of twin but should always include an ECHO. Full evaluation allows many (but not necessarily all) of the anatomic issues to be evaluated.

  4. Separation is not the only alternative. Not all twins are separable and some parents may not desire separation. All alternatives should be discussed.

  5. Surgeons undertaking separation surgeries should be familiar with the literature in order to know how others have dealt with many of the anatomic problems that may be encountered.

  6. A team approach to separation is preferable with 1 lead surgeon to coordinate the overall plan of care. Each twin needs his or her own operative team during separation.

  7. Planning meetings with all surgeons, nurses, anesthesiologists, and other staff are necessary to help plan and coordinate the separation. Rehearsals may help.

  8. Separations may be emergent or elective. In the latter case, separations are most likely to be more successful after 4 months of age.

  9. Surgeons should be familiar with the ethical issues surrounding separation and should be prepared to handle attention from the media.

  10. Outcome from separation depends on the type of twin but may be excellent. Issues regarding quality of life will vary depending on the type of twin. Surgeons should be able to discuss quality of life concerns with families whether the twins are separated or not.

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The topic of conjoined twins is complex. The various types have common characteristics but each set will present unique problems and challenges to overcome. This chapter gives an overview of many of the common themes that surgeons caring for these infants will encounter; however, preparation for the surgery by extensive reading of the literature to examine how others have dealt with these children is essential when caring for these infants.

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Conjoined twins have excited interest and frequently conjured an image of the grotesque throughout history because of their uniqueness, compelling appearance, and infrequent occurrence. However, exactly because of this uniqueness, conjoined twins always attract attention. The realization that two individuals are so intimately connected and must share everything they do is both fascinating and somewhat horrifying to most people. The Western desire to provide each twin with a separate existence has spurred medical science to develop methods for accomplishing safe separation. Separations have now become fairly routine, though they involve great care and planning. To date, well over 1000 cases of conjoined twins have been described, as beautifully documented by Rowena Spencer in her 2003 book entitled Conjoined Twins. Since 1950, more than 200 surgical separations have been documented with an increasing number of successes. It is also important to note, however, that separation in some cases ...

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