Doctors: How we planned for watershed surgery at Kenyatta National Hospital

Kenyatta National Hospital attend to Blessings one of the 2-year-old conjoined twins after a successful conjoined twins separation by a chain of KNH doctors.They will be out of the ICU after two weeks. (PHOTO: JENIPHER WACHIE/ STANDARD)

It cost Sh160 million to perform the 23-hour operation that separated conjoined twins Blessing and Favour.

And it has now emerged that the team that made medical historical had planned for a 10-hour surgery but ended up spending nearly an entire day in theatre.

Celebrations greeted the successful operation carried out at Kenyatta National Hospital last Wednesday; it had taken two years and one month, and 58 specialists to prepare for it.

President Uhuru Kenyatta was among those who congratulated the medical practitioners who participated in the surgery.

The team held hundreds of meetings and rehearsed the delicate operation, first on paper and then on 3D imaging, countless times.

By the time they were stepping into the operating theatre, they were confident that they were up to the extremely delicate task. However, unforeseen hiccups saw the operation that began at 7.49am on Tuesday end at 5am on Wednesday.

"The children were conjoined at the spine as well as the pelvis and its organs. We had to separate the two to allow the wounds to heal without contamination from stool. But we also had to allow the children to pass stool that we had to direct somewhere," said lead surgeon Fred Kambuni.

He said the children now have to wait a year for reconstructive anal surgery.

Just like many other Kenyans, Caroline Mukiri, the children's mother, was pessimistic about the surgery.

"I was not so sure that the surgery would succeed. I fought with myself about whether to consent to it or not. But in the end, I said let God take charge and gave in," she said.

Rehearsals for the surgery were done by creating a duplicate of the twins and separating them on computer to pre-empt any possible challenges.

They dummy runs also involved specialised imaging to understand the children's anatomy.

Paediatric surgeon Hamdun Said Hamdun said they sought to establish "how their blood supply is, to what extent they are conjoined and how the surgery will be carried out so that there is no nerve or artery damage that may later interfere with their limbs".

The rehearsals took two to three hours and involved every aspect of the activity. There were rehearsals without the children, with the children, and these included how they would be wheeled into the life-saving Theatre 12 and to the Intensive Care Unit after the surgery.

"So actually, when we held the knife, there were no surprises at all," he said.

The surgery was conducted in three phases - separation, closing the wound and creating a path where the children will be passing stool.

A big chunk of the money was spent on investigations as this was specialised surgery with no references.

"When we say specialised, it means yes, there are machines and equipment but the hospital had to provide exactly what the doctors needed," said Dr Kambuni.

They even imported four tissue expanders (implants) that cost Sh800,000 each.

The implants were inserted to generate more skin to cover the defects during the surgery as prior investigations had revealed that the twins did not have enough tissue to handle the surgery.

"Such surgeries cannot be read in books. They require tests, and one test can only give us 90 per cent of the details we want. But there is no room for assumptions because we need 110 per cent," Kambuni said

Other aspects that added to the cost were a specialised diet for the children, specialised dressing and medication.

"While we cannot says exactly how much it cost, we can only give the running cost, which is Sh160 million. Part of this will be covered by the National Health Insurance Fund and the hospital," said Dr Joel Lessan.

Doctors are now promising to do more given the right resources.

"With the right resources, there should be no need for harambees to go to India and so on. We have grown to a level where we can provide the same services as New York or London," said Peter Ndaguatha, the chairman of University of Nairobi's Department of Surgery.