- The Washington Times - Sunday, October 12, 2003

DALLAS — A delicate operation to separate 2-year-old conjoined twins from Egypt was proceeding on schedule and without serious incident yesterday.

“Everything is going fine. There have been no problems,” Dr. Jim Thomas, chief of critical care services at Children’s Medical Center, said during an afternoon news briefing. A minor respiratory problem had stopped the operation briefly, he said, but it was of no particular threat to the procedure.

Ahmed and Mohamed Ibrahim, connected at the crowns of their heads, were wheeled into surgery shortly after 9 a.m. The operation was expected to last anywhere from 30 to 90 hours.

The twins have been in Dallas for more than a year, as doctors and ethicists studied their unusual situation and considered whether to attempt to separate them.

A team of about 75 surgeons, anesthesiologists and nurses began preoperative work. By mid-afternoon, they had positioned the tiny patients in a comfortable, accessible position and reportedly had removed much of the expander tissue around the boys’ heads — tissue sewn there in August to allow the boys to grow enough extra skin to cover the wounds created by the operation.

Dr. Thomas said much of the morning was spent in the positioning of the two. The patients lay on a specially built operating table, which after the cutting and restoring of several blood vessels, will be moved apart so the surgeons can finish simultaneously.

“Once [the boys were] positioned this morning,” Dr. Thomas said, “one of the anesthesiologists had some questions about Ahmed’s pulmonary function.”

The medical team stopped the operation when they noticed mucus was partially plugging a tube designed to help Ahmed breathe during the surgery, he said, but it was removed quickly.

The doctor said surgeons had no way of knowing whether one or both boys might suffer some degree of brain damage, and they might not know for several days.

“This is a question I think everybody has struggled with,” he said. “Certainly, the uncertainty as to whether there will be brain damage at all, and if there is brain damage as a result of this, what is the likelihood of it occurring … it’s really very difficult to say,” he said.

“Much of it will depend on what the neurosurgeons see interoperatively, as they go about dividing blood vessels and see response to the brain circulation to each cutting of a vein.”

The twins were born June 2, 2001, by Caesarean section in the small Egyptian town of Qus, about 500 miles south of Cairo.

They were brought here more than a year ago by the World Craniofacial Foundation, a nonprofit Dallas-based organization that has arranged scores of surgeries on patients with severe facial and head deformities.

The boys’ father, Ibrahim Mohammed Ibrahim, has been here with them for about a year. Their mother, Sabah Abu el-Wafa, had stayed in Egypt to care for the couple’s other two children until this past week. Both parents said through interpreters they were anxious but want “to give the boys a chance to be normal.”

Dr. Thomas said the parents were doing well and not only were supported by friends but also “have a very strong faith structure.”

“They have said repeatedly, to all the parties involved, that this is in God’s hands. They take it with certainly more equanimity than I would, facing a similar situation,” he said.

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