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Twin sisters die after surgery

AFP, Singapore
The historic attempt to separate adult Iranian twin sisters joined at the head ended tragically here yesterday when Ladan and Laleh Bijani died within 90 minutes of each other after a marathon operation.
"Raffles Hospital regrets to announce that the Bijani twins, Ladan and Laleh, have both passed away during surgery to separate them," a hospital statement said.
The statement said the twins lost a lot of blood as the neurosurgical stage of the 52-hour operation, in which their tightly enmeshed brains were separated, was coming to an end.
"Doctors' attempts to stabilise them were in vain as their conditions continued to deteriorate," it said.
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The hospital had earlier in the afternoon triggered hope the 29-year-old sisters would survive the operation when it announced that neurosurgeons had successfully separated the twins' heads.
But hospital spokesman Prem Kumar Nair returned shortly afterwards to announce the Ladan had succumbed to massive blood loss at 2:30 pm local time.
Iranian expatriates in Singapore and locals who had gathered at the hospital then pinned their hopes on Laleh, but she died shortly after 4 pm.
A team of 24 doctors and about 100 medical staff, led by Singapore neurosurgeon Keith Goh, began the world-first operation to separate the twins at 10:00am on Sunday, knowing that one or both of the sisters might die.
German doctors refused Ladan and Laleh's plea in 1996 to operate, warning the operation would most likely kill one or both of them, or leave them in a vegetative state.
Since similar operations began 50 years ago, four in five attempts at separation have resulted in severe complications for one or both of the twins.
The Bijani sisters faced a greater risk as they grew older, with all previous operations to separate conjoined twins taking place when the patients were babies.
Goh, who led a team in 2001 that
successfully separated Nepalese babies in a 97-hour operation, said last month he was initially reluctant to lead the surgical team but the twins' determination won him over.
"We gave them the risks very bluntly," Goh said.
"We tried very hard to change their minds because it would be the easiest thing to . . . but we couldn't."
Ladan, generally recognised as the stronger willed and more feisty of the sisters, dominated a press conference last month while speaking in English, a language she only began learning two years ago.
"We don't have any fear about the surgery," Ladan said then when asked about the possibility the operation could kill her and Laleh.
"We feel happy, excited and a little bit nervous, especially me."
Laleh said she and her sister realised the dangers of the surgery but were focused only on a successful outcome.
"We believe God will help us. We go to the gym every day to do exercises and we think positively. Mentally we must think positively," Laleh said.
Although Raffles Hospital officials had remained publicly optimistic throughout the surgery, an ultimately fatal series of complications and delays plagued the operation.
Doctors encountered a six-hour delay on the first day of surgery
while removing a strip of bone that connected the women's heads, when they realised their skulls were thicker and more dense than initially believed.
"It (the procedure) was longer than originally expected because the bones were thick and compact, especially in areas where the two skull bones fused," the hospital said in a statement on Monday morning.
Further complications arose on Monday when surgeons discovered the sisters' brains were more closely linked than previously thought.
"Because they have been fused together for the past 29 years, their brains are very adherent to each other," spokesman Nair told a press conference at 11:00 pm local time on Monday, 37 hours after the operation began.
"The section to separate them is thus taking a long time because the neurosurgeons have to cut through the tissue very carefully, literally millimetre by millimetre."
The team was also unable to control the twins' blood supply.
"We have found that the blood pressure and the pressures in the brain between the two of them tends to fluctuate during the process of the surgery and that is something the team has to take into consideration while they are doing the dissection," Nair said on Monday night.