Separating conjoined twins Rital and Ritag: the journey

Conjoined twins' dad Dr Abdelmageed Gaboura: 'They like to be close'

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"We are very thankful to be able to look forward to going home with two separate, healthy girls," said Rital and Ritag's parents Drs Abdelmageed and Enas Gaboura.

But it has been a long journey. They found out the twins were conjoined six months into the pregnancy.

The children were born by Caesarean section in September 2010, joined at the head - a condition known as craniopagus.

"I was preparing myself to live with conjoined twins twins forever," said Abdelmageed Gaboura.

They were offered surgery to separate the twins at Great Ormond Street Hospital - it is one of the most complex surgical procedures.

Even before the operation the twins had defeated the odds: craniopagus affects one in 10 million births, approximately 40% percent are stillborn or die during labour, a third die within 24-hours, while just 25% survive.

Also, the history of separations, as Great Ormond Street doctors said, is "very much against the odds".

Blood is key

Rital and Ritag were connected by the head. While their brains were separate, they shared one scalp, one skull and as doctors said they "shared a blood supply, which created such a problem."

Surgeons operating One of four operations needed to separate the twins

In fact most of the blood supplied to both brains was draining through Ritag.

By the time the twins arrived in the UK, Ritag was already showing signs of heart failure, her organ could not take the strain of working for both twins. She was also underweight and had a high blood pressure while Rital was "having a fairly easy time of it," doctors said.

Traditionally separating twins has been done in one mammoth operation, however, this has problems.

David Dunaway, lead clinician from the plastic surgery and craniofacial unit at Great Ormond Street, said: "One big operation risks the brain swelling and problems in reconstruction."

Instead they were going to use a technique which had been used successfully twice before - a series of smaller operations.

"It's lots of simple steps, is any one step impossible? No. This is sure and steady, that's the elegance of the technique," he said.

The first two operations on 9 May and 16 May separated the blood flow. Shared blood vessels were given to Rital and there was a delay until the next operation, to give Ritag the time to grow new blood vessels.

Rital and Ritag with balloons under the scalp Inflatable balloons stretch the skin

When the twins had fully recovered from the first operation, inflatable balloons were inserted under the scalp on 4 July. These were gradually inflated to stretch the scalp to grow more skin. This extra skin would be used in the final operation to ensure there was enough to cover both heads.

The twins were finally separated in a 13-hour operation on 15 August.

Mr Dunaway said: "I can't say what a joy it's been for all of us. It is so hard to say what it feels like.

"For them to survive this process, completely neurologically intact and to be a few weeks later smiling, developing, acting appropriately, has been wonderful for us."

The journey is not over. Rital and Ritag have heads which are not normally shaped so they may need more surgery in the future.

They also have some difficulty controlling their heads after lying flat all their lives.

For now though, the twins are getting used to seeing each other.

"It look a long time for them to understand they were related to each other," said mum.

"They like to be close to each other most of the time," said dad.

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