MOH News
Dr. Al-Rabeeah Gives a Lecture at the 7th Dubai International Conference for Medical Sciences
11 December 2012
His Excellency the Minister, and head of the surgical team specialized in separating conjoined twins, Dr. Abdullah bin Abdulaziz Al-Rabeeah, has stated that, thanks to the prudent directives of the Custodian of the Two Holy Mosques, and his continuing patronage for the twin separation surgeries conducted in the Kingdom of Saudi Arabia on patients hailing from all over the world, it has been made crystal clear that our religion, Islam, is a religion of tolerance and humanness, regardless of the patient's color, gender or ethnicity. 

In his lecture addressed before the 7th Dubai International Conference for Medical Sciences, Dr. Al-Rabeeah said, “The Kingdom of Saudi Arabia has managed to take momentous strides that reinforced its leadership in conjoined twins separation. This is to be undoubtedly attributed, in the first place, to the help and guidance of Allah, and then to the gracious patronage of the Custodian of the Two Holy Mosques, May Allah protect him.” Meanwhile, he affirmed that all such efforts are made for the sake of the sons of the Arab and Islamic nations, and all people throughout the world.

Speaking of the Kingdom's extensive expertise in this domain, Dr. Al-Rabeeah mentioned the incidence of conjoined twins all over the world: 1 per 50000 birth-giving cases is prone to this disorder, whereas, in South and East Asia, as well as Africa, it amounts to 1 per 14000 or 25000 cases. This significant rise in Asia and Africa, according to Dr. Al-Rabeeah, can be attributed to the hereditary factors that have to do with identical twins.

He also pointed out that 60% of conjoined twins are stillborns, and that 40% die in days after delivery. Statistics show also that 70% of conjoined twins are females.

Moving on to talk about the clinical classification of conjoined twins, Dr. Al-Rabeeah explained, “These cases can be divided to conjoined twins with two lower limbs, twins with three lower limbs and twins with four lower limbs. The conjoined twins are caused by the pollination of one oocyte, which leads to twins of the same gender, and carrying the same genetic traits.”

It followed that Dr. Al-Rabeeah enumerated the kinds of conjoined twins: abdominally conjoined twins, lower conjoined twins, and head conjoined twins.

As for the reasons for the incidence of conjoined twins, Dr. Al-Rabeeah pointed out that actual reasons are unknown. Some studies, however, attribute it to the uncompleted separation of the oocyte, with the effect that it rejoins, due to lack of separation stimuli. 

Moreover, Dr. Al-Rabeeah, during his lecture, touched upon the diagnostic phases of conjoined twins, pointing out that such cases can be diagnosed during pregnancy, as well as after delivery, by means of the usual radiological imaging, as well as the magnetic radiation. That's to be added to examining the heart, arteries, CT-scan, in addition to nuclear radiation.

While explaining the various stages of the separation surgery, Dr. Al-Rabeeah reiterated the importance of planning prior to the surgery, by forming a multi-disciplinary team, and getting an approval to conduct the surgery, in addition to preparing a written plan for the surgery, and conducting a rehearsal beforehand.

Further, he drew attention to the fact that the Kingdom's expertise on this field is a successful and extensive one as it exceeded twenty years: from 1990 to 2012. It also witnessed a lot of successes which made the Kingdom's name distinctive in the field of medicine, and it gained a reference expertise on the field of twin separation, in addition to having a specialized medical team on this field. He went on lauding the team's efforts, and affirmed that this success materializes the efforts of a fully fledged team work, and in the future , the early surgeries of Siamese twins will be conducted either when giving birth or before birth-giving.

In the meantime, Dr. Al-Rabeeah stated that the expertise of the Saudi medical team amounts to 69 conjoined twin cases that extended for 22 years, during which 30 successful separation surgeries were conducted. Whereas the other cases were suffering from congenital defects and were not apt to be medically separated. There are still other cases on the waiting-list. He went on pointing out that all these cases were tackled through the one-team experience, to the effect that the work was distributed to 69 groups; whereas before birth-giving diagnosis is conducted in 49 groups and cesarean section was assigned 49 groups. He also made clear that these cases were distributed to 17 states included all the world's continents; of which there are 35 cases from the Kingdom, 7 from the Sudan, 5 from Egypt, 2 from Yemen, 3 from Cameroon, 3 from Morocco, 3 from Iraq,  and 2 from Syria. And there is one case from each Oman, Malaysia, the Philippines, Poland, Somalia, Bahrain, Palestine, Jordan, and Algeria. 
  
Within the same vein, Dr. Al-Rabeeah distributed the cases which were separated in the Kingdom, according to its degree of conjoin, to several places. He pointed out that there are 24 cases conjoined at the chest, 21 cases conjoined at the abdomen, chest, and pelvis. Whereas there were 6 cases conjoined at the abdomen, 7 cases conjoined at the pelvis; and there were 7 parasitic twin cases, 3 cases conjoined at the thigh, and one case conjoined at the head.

He said that the number of cases which was separated amounted to 30 cases from several nationalities and they were distributed to all the world's continents; whereas there is still one case on the waiting list. He went on adding that the reasons behind not separating some cases are that some of them were suffering from congenital defects such as having one heart, significant malformations, having connection between the twins' hearts; and other congenital defects that cannot sustain life. 

Finally, he pointed out that judging by the long, extensive experience, the cases are tackled through several methods. This is through one team that includes two teams; one of them has multiple specialties and the other is a surgical team. Thus, this team conducts several precise examinations before the surgical decision, through several meetings and consultations made by the team, along with sharing parents in the discussion from the beginning. This is followed by the psychological and social therapy for parents, especially during the operation. Hence, a simulation operation is conducted. In addition, parents are familiarized with ways of dealing with all mass media before, during, and after the operation.




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