Elalia Kherkhar, Twin’s mother: “I never believed for a single day that anything bad would happen to my daughters. I had a feeling it was going to be good. I was listening to the morning adhan (call to prayer) every day and I was filled with the same good feeling.”
Safaa and Chifaa were 5-month-old conjoined Siamese twins when they were brought to Turkey from Algeria… They were born facing each other; they were attached from the anterior chest wall to their abdomen! The pericardium and liver were fused together, and the thorax and ribs were deficient. Moreover, due to Şifa’s hydrocephalus, fluid was accumulating in her brain, her head was growing rapidly, and her neurological development was getting worse day by day. Other countries stepped in so that conjoined baby girls could be separated and regain their own bodies, but they were brought to Acıbadem University Atakent Hospital to be entrusted to Turkish physicians on December 15, 2021, under the patronage of Algerian President Abdelmadjid Tebboune.
Before and after the separation of the twins, the team of health army consisting of 100 people included Pediatric Surgery Specialist Prof. Dr. Burak Tander and his team, Pediatric Cardiovascular Surgery Specialist Prof. Dr. Ersin Erek and his team, General Surgeon Prof. Dr. Remzi Emiroğlu and his team, Plastic, Reconstructive and Aesthetic Surgery Specialist Prof. Dr. Mehmet Veli Karaaltın and his team, Anesthesiologist Prof. Dr. Tayfun Güler and his team. In addition, Pediatric Intensive Care Specialist Prof. Dr. Agop Çıtak and his team, Pediatric Infectious Diseases Specialist Prof. Dr. Metehan Özen, Pediatric Diseases Specialist Dr. Barış Yazar and Neurosurgery Specialist Prof. Dr. Kenan Koç and his team were also on duty.
Burning the candle at both ends, weeks and months passed with the work of a multidisciplinary, experienced and meticulous team. After 6 months of preparation, the conjoined twins were successfully separated on June 6, 2022 as a result of a 9-hour surgery. After the surgery, the 4-month treatment process was completed. Safaa and Chifaa, who are 15 months old today, were discharged from the hospital where they stayed to return home with their parents who experienced indescribable joy. Here are the milestones of Safaa and Chifaa’s ‘separation from their conjoined bodies and rebirth’ process in Turkey, the gratitude of the parents and the stories of the doctors…
“We had the shock of our lives!”
Algerian couple Elalia Kherkhar and Ibrahim Kherkhar had two healthy children named Muhammed Emin and Selahattin. They were excitedly preparing to welcome their third child in their arms . However, when the 26-year-old young mother reached her fifth month of pregnancy, she was shaken by the news that her twins were conjoined. Nightmare days had begun for the parents who said, “We had the shock of our lives, we could only tell this to our family.” In fact, the Kherkhar couple had twins in their family; Abraham Kherkhar had twin brothers, but one died at birth. Elalia Kherkhar’s aunt also had twins, one of whom also died at birth.
Becoming exhausted, experiencing the stress of the uncertainty that awaited them while at the same time trying not to reflect it on their two young children. Then Safaa and Chifaa were born; they were adhered to each other from the chest wall to the abdomen with their faces facing each other.
She went to the hospital, 1 hour away, to see her babies every day!
Elalia Kherkhar was discharged from the hospital on the third day of birth, but her mind and heart were on her conjoined babies in the intensive care unit. Every day, she was going to the hospital to see her daughters from her home, which is an hour away. Moreover, during these long journeys, she also felt pain due to cesarean section, but seeing her daughters was more important than her pain.
The news about conjoined twins was followed all over Algeria, even Algerians living in countries such as Italy, Spain, India, Saudi Arabia and France heard it. They also came out and searched in the countries they were in to find a hospital that would separate the conjoined twins. Elalia Kherkhar says, “There were so many people calling to cheer me up, to recommend a hospital, I couldn’t reach my husband by phone, his phone was always busy” And this close solidarity of Algerians achieved its purpose. Conjoined twins were brought to Acıbadem University Atakent Hospital in Turkey on December 15, 2021 under the patronage of Algerian President Abdelmadjid Tebboune, although many countries invited them to their countries for treatment. This is how the journey to the beginning of the happy ending began.
“At every call (adhan) for morning prayer, I felt that they would heal!”
The Kherkhar couple felt the sadness of leaving their two sons, aged 3.5 and 5, in Algeria, while worrying about the fate of their conjoined baby girls. “They also heard that they were conjoined twins. My younger son didn’t really realize it, but my older son said, ‘Mommy, was I conjoined too? Can we separate my sisters if we cut their skin?” he asked when we were in Algeria. I knew he was upset” she says.
Stating that she was always hopeful from the moment she became pregnant and never for a single day thought that something bad would happen to her babies, mother Elalia Kherkhar said, “During my pregnancy, they told me that they were conjoined, but they also said that they could be separated. After the birth, I was shocked when they told me that they could die at any moment in intensive care. But believe me, even in those days, nothing changed in my feelings. Not a single day did I ever believe that anything bad would happen to my daughters. I had a feeling that it would be good. Every day I listened to the call to prayer in the morning and I was filled with the same beautiful feeling.”
“Let them keep their faith, their mood up”
The mother, Elalia Kherkhar, expresses that they are happy with the long, tedious but successful treatment process, and says that conjoined twins can be born again in different countries of the world and their parents can experience different emotions like they did. She gives the following advice to families with conjoined twins: “They should keep their faith up, because Allah will surely bring good doctors in front of them and help them”. The father, Ibrahim Kherkhar said, “Choosing the right hospital is very important. The right hospital has the right team. We received the right service at the right address where we came for our children to be healed, so we are very lucky. As parents, we were very patient, we had very difficult days psychologically. We waited for months for skin expansion operations, but nothing was in vain, now we have been discharged with all the procedures and treatment completed, and we are returning home. We would like to thank the Algerian President Abdelmadjid Tebboune, Algerians and the Turkish people.”
Expressing that they will celebrate 2 birthdays in the future, the family says, “The day they came into the world and the day they were separated will be two separate birthdays for us.”
The health army of 100 people was mobilized!
A health army of 100 people at Acıbadem University Atakent Hospital had been mobilized for this separation! When they came to the hospital on December 15, they burned the candle at two ends as one heart, in harmony like the five fingers of one hand. Pediatric Surgery Specialist Prof. Dr. Burak Tander and his team, Pediatric Cardiovascular Surgery Specialist Prof. Dr. Ersin Erek and his team, General Surgeon Prof. Dr. Remzi Emiroğlu and his team, Plastic, Reconstructive and Aesthetic Surgery Specialist Prof. Dr. Mehmet Veli Karaaltın and his team, Anesthesiologist Prof. Dr. Tayfun Güler and his team were present at the surgery. In addition, Pediatric Intensive Care Specialist Prof. Dr. Agop Çıtak and his team, Pediatric Infectious Diseases Specialist Prof. Dr. Metehan Özen, Pediatric Specialist Dr. Barış Yazıcı and Neurosurgery Specialist Prof. Dr. Kenan Koç and his team were on duty as well. After examinations and studies conducted by many physicians, internal organ anatomies were created in 3D on a computer program and models were prepared. Experts made rehearsals and virtual surgeries on the model before the surgery and prepared for the surgery by planning the possible risks in the finest details. Since Şifa, one of the conjoined twins, had advanced hydrocephalus, fluid accumulated in her brain, her head was enlarging and she had neurological problems. Before the surgery, the Neurosurgery team performed a shunt surgery to drain the fluid accumulated in the brain to stop her hydrocephalus and control her neurological problems. On the other hand, since there was not enough skin tissue to cover the gap in the anterior chest wall when the twins were separated, the skin was expanded in February to produce skin. And the conjoined twins were successfully separated from each other in a 9-hour surgery on June 6, 2022. The twins, who received strict treatment in the hospital for 4 more months after the surgery, were discharged happily, regaining their own bodies, health and physical freedom.
What did they do? What did they feel?
Prof. Dr. Remzi Emiroğlu, Faculty Member of Acıbadem University and Head of Organ Transplantation Department at Acıbadem University Atakent Hospital, Liver Transplant Supervisor, said: “”Although there is not much information in the literature, when I saw that success rates can reach up to 80 percent after surgeries performed by planned and experienced teams, I thought that we could do this job. We prepared very well by working on a three-dimensional model, we almost memorized every anatomical detail. Radiologically, we repeatedly studied how we could separate all the vessels and bile ducts. The most critical point for us in the separation of Safaa and Chifaa’s conjoined bodies was that we cut the liver evenly and there were no complications. With a meticulous and experienced team, we did not encounter any surprises. We managed to divide the liver into two equal parts exactly as we planned.”
Acıbadem University Atakent Hospital Brain and Nerve Surgery Specialist Prof. Dr. Kenan Koç stated that Şifa was congenitally advanced hydrocephalus, therefore, fluid accumulated in her brain and her head was constantly growing. We worked very hard and meticulously as a team. We performed shunt surgery to drain the fluid accumulated in Şifa’s brain. After a very difficult process, her situation is better now. The growth on her head stopped progressing, and she became more neurologically adaptable. Teamwork is extremely important in conjoined twin cases. We got together as a team, successfully reunited the twins and performed their treatment.”
Prof. Dr. Agop Çıtak, Faculty Member of Acıbadem University and Pediatric Intensive Care Specialist at Acıbadem University Atakent Hospital, summarized the intensive care process as follows: “We were facing a very challenging and complex process. Since serious complications might develop both during and after the surgery, we prepared as a team by considering all scenarios and all possibilities. When the children came to the intensive care unit right after the surgery, all preparations were already in place. Safaa and Chifaa were immediately connected to monitors. They were monitored on artificial respiration. Şifa’s need for intensive care was higher due to her neurological problems, but we managed to take them both to their rooms in good health. We successfully discharged the twins as all rings of the chain worked perfectly, from an experienced team to the hospital infrastructure.”
Aesthetic, Plastic and Reconstructive Surgery Specialist Prof. Dr. Mehmet Veli Karaaltın, emphasizing that the most important factor in their success in reuniting the twins with their own bodies and being discharged from the hospital in good health, is teamwork and said, “With a good teamwork, we have accomplished many firsts in this surgery. It was necessary to produce skin because there was not enough skin tissue to cover the gap that would form in the anterior chest wall when the children were separated. For this reason, in February, we placed inflatable subcutaneous expanders on both sides of the children, gradually inflating them to expand the skin. We used the most advanced plastic surgery techniques so that his vital organs were not exposed after the operation. For the first time, we have increased the vascularity of the tissues using the placental membrane by being free of cells.”
Pediatric Health and Diseases Specialist Barış Yazır states that he has seen the conjoined twins every day since they came to the hospital, emphasizing that he closely witnessed not only their recovery to their own bodies but also their mental improvements with a successful surgical operation. Dr. Barış Yazır said: “The fact that 30 percent of Safaa and Chifaa’s bodies were adhered, especially the adhesions from the chest wall to their abdomen, broke their relations with the environment. Şifa was sleeping all the time due to her neurological problems, she had frequent seizures, which was also challenging for her sister. But it is an indescribable happiness to witness them step into their new lives with a very successful team work in a 10-month period and to share in their family joy.”
Acıbadem University Faculty Member and Acıbadem University Atakent Hospital Anesthesiologist Prof. Dr. Tayfun Güler also speaks as follows: “We achieved this success thanks to the experience of all the teams and anesthesia team involved in the separation operation of conjoined twins, and their meticulous work, working day and night in close cooperation. Thanks to our hospital’s state-of-the-art technology for this type of surgery, everything needed was at our fingertips. We made our preparations for all kinds of contingencies. Everything was under control during the 9-hour surgery. I can say that when we saw the babies separately for the first time after the surgery, I was extremely emotional. The children were taken to the pediatric intensive care unit on a ventilator. We handed it over to the hospital’s pediatric intensive care team, into their compassionate and knowledgeable hands. Today, we are happy they are discharged in good health”.