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Dr. Sanjay Gupta: 'Tragic outcome' for twins

CNN's Dr. Sanjay Gupta
CNN's Dr. Sanjay Gupta

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Doctors say conjoined Iranian twins Laleh and Ladan Bijani died during the landmark surgery to separate them. (July 8)
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(CNN) -- The risky surgery to separate conjoined Iranian twins Ladan and Laleh Bijani ended tragically Tuesday with the deaths of both women, a Singapore hospital said.

The operation was a landmark procedure. Singapore doctors had performed a similar operation in 2001 on infant Nepalese girls, but surgery on adult twins was unprecedented.

CNN Medical Correspondent Dr. Sanjay Gupta joined Anchor Bill Hemmer on Tuesday to discuss the complications leading to the deaths of the sisters, who were 29.

GUPTA: You know, it had never been done before on adults -- that is separating of conjoined twins. So certainly I don't think anybody knew fully what to expect.

There were a couple of major obstacles which were crossed early on in the operation for the twins. First of all, this blood vessel [that served to drain both twins' brains] that we have been talking so much about had been rerouted.

I was just listening to some of the comments from the doctors ... and they said that even though that blood vessel had been rerouted, a lot of pressure was still building up in the brain of one of the twins, and they actually had to create another bypass to, in fact, create another blood vessel to drain even more of the blood.

The problem being ... was that if there's too much pressure in the brain, the brain starts to bleed sort of more diffusely all over the brain. In fact, that's exactly what happened after the separation had occurred.

First Ladan, and then Laleh Bijani -- Ladan a few hours before Laleh passed on due to profound bleeding. And it sounds like Laleh also experienced that same sort of bleeding.

These are the sorts of complications, sorts of problems in neurosurgery that are the most difficult to control. Bleeding in the brain can be extremely challenging. We are talking about blood vessels that are microscopic in size; we are talking about making cuts, length wise along a piece of paper -- very, very fine, very precise. Little room for error. If there is error, this sort of bleeding can occur as well.

Obviously, a tragic outcome here. At best, when we spoke to Ben Carson [director of pediatric neurosurgery at Johns Hopkins, who assisted in the surgery] before the operation, he said 50/50. As it turns out, it wasn't -- didn't turn out to be well for either twin.

HEMMER: You touched on it briefly there, and you've talked about this since the procedure began. The amount of tissue and growth that happens after two brains grow together and live together for 29 years, was that the breaking point that left this tissue so delicate and so difficult to separate?

GUPTA: I think that that was a lot of it. No question. Twenty-nine years of fusion of one brain to the other -- [it's] very different than the fusion of two newborn brains, for example. That made it very, very difficult. The brains have sort of grown together, making those cuts again very, very challenging.

Imagine this, Bill, tangles of blood vessels that the surgeons would encounter as they're making these cuts, even making it more challenging. But again that pressure inside the brain causing that excessive bleeding probably also contributed to this.

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