Iranian twins die after separation operation fails

Twin Iranian sisters joined at the head since birth 29 years ago died within hours of each other yesterday after surgeons in Singapore separated them in an operation they knew could cost their lives.

The deaths of Laleh and Ladan Bijani from massive blood loss after an historic 52-hour operation by 28 specialists and 100 assistants plunged Iran into grief and brought shock and tears to Singapore's Raffles Hospital, where the surgery took place.

"We were hoping to try and do better than the worst odds. But alas we didn't make it," hospital chairman Loo Choon Yong told reporters.

"When we undertook this challenge, we knew the risks were great. We knew that one of the scenarios was that we may lose both of them. Ladan and Laleh knew it too," Loo said.

The twins, who died within 90 minutes of each other, said last month they were willing to risk death for the chance to live separately because of their very different personalities.

Both had law degrees, but Ladan - the more outspoken of the two - wanted to be a lawyer in their home town of Shiraz while Laleh wanted to be a journalist in Tehran.

The operation, led by neurosurgeon Dr Keith Goh, ran into several major complications. The women's blood pressure had been fluctuating and surgeons discovered the brains were more closely linked than previously thought.

The operation began on Sunday, when doctors opened the joined skull. The bone was surprisingly thick, causing delays.

On Monday, the surgical team battled to reroute a shared vein draining blood from the twins' brains to their hearts. Then neurosurgeons pried apart the brains millimetre by millimetre.

By yesterday morning, they had teased apart the tightly packed brain tissue and blood vessels, and the doctors announced the twins had been separated, causing a roar of applause and cheers from friends and supporters keeping vigil at the hospital.

But Ladan, considered more at risk after receiving a new vein the size of a finger grafted from her thigh, began losing blood. She died at 2:30 p.m. (0630 GMT). Surgery continued on Laleh, but she passed away 90 minutes later.

"It is a sad day for Iran," Vice-President Mohammad Ali Abtahi told Reuters. "The Iranian nation and a lot of people around the world were looking to the hospital hoping these two would be rescued."

The twins' father, Dadollah Bijani, a poor farmer from southern Iran, said the sisters were kept in a local hospital for years under the care of US doctors, but went missing during the confusion of Iran's 1979 Islamic revolution.

He eventually tracked them down to Karaj, near the capital Tehran, where doctor Alireza Safaian had adopted them.

A court awarded father-of-11 Bijani custody, but the twins decided to stay with Safaian, who said the twins had been abandoned before he adopted them, with even hospital staff unwilling to look after them.

Singaporean Armila Teo, 48, wept in the hospital lobby after hearing news of Ladan's death. "I'm very upset," she said. "Even if I'm not related, the emotion just overcame me."

Twins joined at the head occur only once in every two million live births, and successful separation is even rarer. It has never been performed on adults. German doctors turned the Bijanis away in 1996, saying separating them could be fatal.