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Conjoined twins separated

Physicians separate heads of 2-year-olds in marathon surgery

DALLAS -- Two-year-old Egyptian twins joined at the top of their heads were successfully separated yesterday, but face a long recovery after the marathon surgery that began a day earlier and that took more than a year of planning.

At the news of the successful separation of Ahmed and Mohamed Ibrahim, parents, surgeons, and caregivers were overjoyed.

"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 one of the twins' doctors in Egypt. "The mother, on the other hand, was crying like everybody else. She was there thanking everybody around and thanking her faith that brought her to this great place -- Dallas, Texas."

As surgeons worked to finish closing the boys' head wounds, part of the medical team at Children's Medical Center Dallas talked yesterday about the successful completion of the surgery.

Ahmed and Mohamed, who had an intricate connection of blood vessels but separate brains, were physically separated about 26 hours after they entered the operating room. Doctors then went to work covering the head wounds.

Doctors said the boys were medically stable, and the surgery went according to plan. Concerns now include the risk of infection and how the wounds will heal.

Dr. Kenneth Salyer, a craniofacial surgeon who founded the World Craniofacial Foundation, which brought the boys to Dallas, said his feelings had ranged "from moments of ecstasy to moments of anxiety."

Dr. Dale Swift, a pediatric neurosurgeon, said it was too early to tell whether the boys would have neurological damage.

After leaving the operating room, the boys will be taken to an intensive care unit, where they will remain in a drug-induced coma for three to five days. Both boys will need additional reconstructive surgery in coming years.

The boys were born June 2, 2001, by Caesarean section to Sabah Abu el-Wafa and her husband, Ibrahim Mohammed Ibrahim. They are from el-Homr, about 400 miles south of Cairo.

A team of specialists determined in June 2002 that the boys could be separated, though the risks included brain damage and death. The boys' father told doctors he felt it was worth it to give them a chance at normal lives.

There have been at least five surgeries around the globe in the past three years to separate twins joined at the head. Three were successful. One resulted in one twin dying, and in another, both twins died.

On Saturday, 4-month-old twin girls from Greece who were joined at the temple were successfully separated during surgery in Rome. The ANSA news agency said the 12-hour surgery was simplified, because the infants didn't share any organs.

In el-Homr, villagers have been praying in mosques for the twins "to return safely," said Mohammed Ibrahim, 65, the twins' grandfather.

"If this is true, then this is very good news," Nasser Mohammed Ibrahim, the twins' uncle, said after learning of the separation.

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