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Twins are ‘remarkably stable’

Two-year-old twin boys from Egypt who had been joined at the head spent their first night apart after 34-hour separation surgery and a doctor said Monday they were in “remarkably stable” shape.

The surgery to separate little Ahmed and Mohamed Ibrahim began Saturday morning at Children’s Medical Center Dallas and ended late Sunday afternoon. They remained in critical but stable condition Monday in adjacent rooms.

“After coming back from the operating room last night, the twins have had a remarkably stable course,” said Dr. James Thomas, chief of critical care at the hospital. “They have really thrown us no surprises in the process.”

He said their blood pressure was stable and kidney function “perfect,” and a routine scan Monday morning showed minimal swelling in their heads. They were on mechanical ventilators and were to remain in a drug-induced coma for 2½ to three days.

Doctors stressed there were still concerns: the possibility of stroke, infection and how the wounds will heal, and long-term questions about brain damage from the surgery.

The boys’ father, Ibrahim Mohammed Ibrahim, fainted when he heard the operation was over.

“At one point when someone came up and said, ‘you have two boys,’ the father jumped to my neck and he hugged me and he fainted and I cared for him,” said Dr. Nasser Abdel Al, who was with the family for the marathon operation. He is head of neonatal surgery at a Cairo hospital where the twins were taken shortly after their birth.

“He told me that he never dreamt of such a moment,” said Abdel Al. He added that Ibrahim’s wife, Sabah Abu el-Wafa, “was crying like everybody else.”

The intricate operation had been in the planning stages for months. The surgery team used a specially made operating table that let doctors swivel the boys’ bodies for easy access to the front and back of their heads.

At a news conference Sunday afternoon, part of the medical team talked about the road ahead for the boys.

“We’re very pleased with the surgical outcome,” said Dr. Dale Swift, one of five pediatric neurosurgeons involved, “but the post-surgical care is extremely important - really can determine your outcome. So right now, we’re waiting.”

They will spend the postoperative phase at Children’s until they are stable. Then they will be moved back to North Texas Hospital for Children at Medical City Dallas, where they were cared for before arriving at Children’s on Thursday.

They will need additional reconstructive surgery in coming years.

Dr. Kenneth Salyer, a craniofacial surgeon who founded the World Craniofacial Foundation that brought the boys here, said his feelings had ranged “from moments of ecstasy to moments of concern and anxiety.”

Swift described an unexpectedly difficult moment separating the left hemisphere of Mohamed’s brain from part of Ahmed’s. “It was very, very stuck together.”

He said it was too early to tell what kind of neurological damage the boys might have.

The boys were born on June 2, 2001, by Caesarean section.

The Dallas-based World Craniofacial Foundation, a nonprofit group that helps children with deformities of the head and face, arranged to bring the boys to Dallas in June 2002 for an evaluation.

In the boys’ hometown of el-Homr, some 400 miles south of Cairo, villagers have been praying in town mosques for the twins “to return safely,” said Mohammed Ibrahim, 65, the twins’ grandfather.

As conjoined twins, Mohamed and Ahmed smiled and giggled, babbled in English and Arabic and tried to move around any way they could. But experts had said they were getting behind in their development, compared with other children their age, because they were unable to explore their world.

When doctors concluded that a separation surgery was possible, the risks were explained to the parents. The boys’ father told the doctors to go ahead.

“If they’re left this way, they’re not going to be normal,” Ibrahim said through a translator earlier this year.