Two-year old Lakshmi - named after the Hindu goddess she somewhat resembles with her four arms and four legs - comes from a small village in the district of Araria, located on the border of Nepal, in Bihar.
Lakshmi is an Ischiopagus conjoined twin. Ischio stands for pelvic bone and pagus means fused. Therefore, Lakshmi is actually two bodies united at the pelvis. Only one of the twins has a head and the other is a parasite. Two pairs of arms and legs have formed at either end of the two adjoining torsos, creating a child with 8 limbs. The incidence of conjoined twins is 1 in 50,000 Lakshmi's kind of twin forms only 3% of all types of conjoined babies.
Poonam gave birth to Lakshmi in her mother's home village without any form of medical supervision, and neither did she receive any antenatal care during her pregnancy. When Lakshmi was born, it invoked tremendous curiosity in the village. Hordes of people started turning up from the neighboring areas to see the incredible Lakshmi.
Lakshmi comes from a very impoverished background. Since Lakshmi's birth, her parents, Shambu and Poonam, have faced innumerable ordeals - socially, medically and mentally - in trying to raise her. She is the younger of the two siblings - her brother Mithilesh is 6 years old.
Lakshmi at Sparsh…….
She was admitted to Sparsh Hospital at the beginning of October 2007 - the first time that she and her family have traveled so far away from home. On arrival, immediate tests revealed that she was extremely mal-nourished, and had hemoglobin of 5.4 gram percent as opposed to 12 gram percent in normal children. She was suffering from an infected pressure sore on the dorsum of the parasitic twin measuring almost 6 inches in diameter - causing her to run a constant fever. She also had a parasitic helminthic infestation of her bowels.
It became imperative to improve Lakshmi's nutritional status and general well being which was done by de-worming her and putting her on a high-protein calorie diet. Simultaneously, a battery of blood and urine investigations were carried out including ultrasound tests, whole-body MRI scans and a 64 slice CT scan. All the data from the tests has been thoroughly examined and discussed.
Now with an improved nutritional status and an increased hemoglobin of 11 gram percent, surgery has been scheduled to begin at 0700 hrs on November 6th 2007. The operation is expected to go on day and night, and likely to take up to 40 hours to complete. The medical team, supported by paramedical staff, will number a total of approximately 36 members.
The 40-hour Countdown
A sleepy little Lakshmi was wheeled into the operating theater at 0700 hrs in the morning of November 6th 2007. She was anaesthetized and all monitoring equipment was placed, before - following careful preparation - the surgeons began to work. The child was carefully monitored throughout the long surgery and all necessary corrections were carried out immediately throughout the operation.
The pediatric surgery team operated on her first and carefully dissected out vital organs so that they could be preserved during removal of the parasite. Lakshmi's internal structures were not exactly as they had appeared on the scans, but the surgeons were able to negotiate these difficulties. As Lakshmi herself had only one kidney, a second kidney from the parasite was successfully isolated and moved into Lakshmi's body.
Then the neurosurgeons began the delicate process of separating the Lakshmi's spine from the spine of the parasite. This was accomplished without any major complications.
Next the orthopedic team led by Dr Sharan Shivaraj Patil went in to perform the crucial part of the surgery - "the pelvic osteotomy". The bones in Lakshmi's pelvis were split apart in order that they could be moved closer to each other to form a ring, thus supporting Lakshmi's internal organs above. The lack of space caused by the proximity of the parasitic body, and the continuing discovery of unforeseen internal structures, made this a difficult part of the operation. It was also very important that the ring of Lakshmi's pelvis could be closed as tightly as possible in order to give her the best chance of walking in later life. In a daring move, Dr Patil used some of the pelvic bone from the parasitic twin to reconstruct Lakshmi's pelvis into a rounder and more successful shape than had been expected - giving her a very good chance of a normal walking gait later in life.
The climax of the operation at 12.30 am on November 7th. It was a spectacular moment when the legs, arms, and remainder of the parasitic twin were removed from Lakshmi and held in the hands of the Dr Sharan Patil. The Plastic and Micro vascular surgery team then stepped in to perform the soft tissue reconstruction and close the open wound. The whole surgery was completed at 10 am in the morning.
On completion of the surgery, there was a great sense of elation for having achieved everything that the entire team had set out to do. Lakshmi was shifted out to ICU were she is being monitored round the clock. Her condition is stable. But the next 48 to 72 hours are critical. And the whole team is constantly monitoring her in order to ensure that her vital signs remain normal and so that her recovery continues as quickly as possible.
Sparsh Hospital wants to thank the Indian public and people from around the world for their prayers and support without which this landmark surgery would not have been possible. With you we will hope and pray that Lakshmi will continue to make great progress in days and weeks ahead.
Lakshmi Tatma: Post-Op Update
9th November 2007 at 1600 hours
Lakshmi Tatma has now been in ICU for approximately 54 hours. Her condition has continued to remain stable during this time. Lakshmi opened her eyes for the first time yesterday. In addition, she managed to move her fingers and toes. She continued to be ventilated overnight.
Shambu and Poonam Tatma visited their daughter in the ICU. They spent about 15 minutes at her bedside.
This morning, all of Lakshmi's blood parameters were within normal limits. We started weaning her off the ventilator around 0800 hrs, and were able to take her off the ventilator completely within a few hours. She has been off the ventilator since that time, with all parameters continuing to remain stable.
Shambu and Poonam Tatma revisited Lakshmi again today at 1600 hrs.
Dr Sharan S Patil and Dr Yohannan John from the Sparsh Hospital, Narayana Health City, Bangalore
10th November 2007 at 1600 hours - Day 4
12th November 2007 at 1600 hours - Day 5/6
13th November 2007 at 1600 hours - Day 7
Lakshmi Tatma is going home today