A medical achievement in the midst of the collapse: the first twin separation operation in Lebanon … Their mother told An-Nahar: Do not despair


In light of the blackness in which the health sector was plunged in the past years as a result of the crisis, and in light of smuggling and the shortage of medicines and medical supplies, hope was growing in a small place far from the light. He began to grow up little by little before he was announced today with a medical achievement, the first of its kind in Lebanon, by performing the first twin separation operation at the American University Hospital in Beirut.

In 1975, Lebanon witnessed the birth of the first conjoined twins, but the separation process was not performed and it was not known what happened to them. Today, the announcement was made of the first twin separation operation in Lebanon, and they are in good health, and they are still in the hospital for follow-up.

Rahaf and Reem are two girls who had a better life and future after they were rescued from being stuck in the lower back. The beginning of the story was 6 months ago when the caretaker Minister of Health, Firas Al-Abyad, received a call stating that there was a case of conjoined twins in need of assistance. Indeed, the birth was in Lebanon, not abroad, and the twin separation surgery took place in one of the operating rooms at the American University Hospital, bringing to mind the success of the twin separation operation in Saudi Arabia weeks ago.

Returning to the mirrors of the twins’ mother, we begin to tell the story of this family who lives in Tripoli.

Two months after her pregnancy, Maraya Abdullah Malas had to face the bitter truth that would accompany her throughout her second pregnancy. The expressions of Dr. Sawsan in Tripoli were not reassuring. In the bowels of Maraya were two fetuses lacking an organ that had not yet appeared. The first visit was not worrisome, the doctor wanted to ease her fears until the picture became clearer, but for Maraya, her exit from that clinic was not the same as entering it, something broke in her heart and her thoughts floundered silently.

Maraya had to see the doctor every 3 weeks to follow up on her rare condition. The issue was no longer just a hypothesis, but a difficult fact that unfolded month after month, and that the twins were stuck between them inside her guts. The two fetuses did not move in her womb, they were always in the same position, and the dependence on the time factor, which soon disappeared, and the possibility of seeing them separately became remote.

In the fifth month of pregnancy, a mirror doctor decided to refer her to a doctor specializing in fetal medicine to perform an accurate and detailed ultrasound imaging, and the inevitable result was “the twins are attached and there is only one way out.”

Maraya has surrendered her affairs to God, in her opinion, because these twins are my children, and I will accept them as they are, and I will search for all available treatments that can be offered to improve their condition. I did not expect that the cost of the surgery would be so high and in huge amounts, and we were not able to secure the required cost. I found myself facing a dead end, and decided to seek help from the district deputy in Tripoli, Ahmed Al-Khair, who in turn contacted the Minister of Health to inform him of the details of the medical file and its reasons.”

Maraya’s fear was not a rare medical condition, her only concern was the financial obstacle, especially since a surgery of this kind requires huge sums of money.

Birth and expectation

On September 16, Maraya gave birth to Rahaf and Reem by caesarean section at the American University Hospital, after he adopted this case and accepted the challenge in cooperation with the Ministry of Health. She carried them in her hands as if they were one fetus, and hoped that the surgery, the first of its kind in Lebanon, would succeed in separating them and making her live her motherhood in full, without obstacles or fear.

Four months after their birth, the medical team at the American University Hospital in Beirut decided to perform the first successful separation of the twins.

Maraya admits, “I calmed down before entering to see my two daughters. I was well aware that what awaits me was not normal, but rather a special and rare case. Inside, I was tearing apart, but at the same time I was insisting on seeing them. I entered them and saw them, and my feelings held firm until I got out of there, and as soon as I entered my room in the hospital until I collapsed crying.”

The first stage was difficult and the most difficult moments, as Maraya describes, “when I had to go home without them, but today when I look at the result after all this fatigue, anxiety and fear, I can only say, “Thank God for everything. Today I have separate twins, each child has his own body.” They are healthy, I don’t want more than that.”

What Maraya went through made her more grateful for health and hope. She knows full well that she would not have gone through this experience on her own, and therefore she addresses everyone by saying, “Do not despair of God’s mercy, and the Lord of the Worlds has been kind to us and put people on our way who helped us complete this surgery.”

10 hours straight

In an exclusive interview with “An-Nahar”, the head of the neonatal intensive care unit, Dr. Khaled Younes, explains, “It is important to know that the separation process cannot be performed for all conjoined twins, especially if the main and vital organs are conjoined, such as the heart. But in the case of the twins that we worked on It had adhesion in the lower back (i.e. the pelvic area). These operations carry great challenges and the risk of complications, which requires careful and continuous follow-up for months, and this is what really happened with the twins, as we worked for 4 months before performing the separation operation.”


Yunus confirms that the surgery was a success without any complications, and the reason is due to the intensive meetings (7 meetings throughout this period), where the medical team worked to deal with all the risks and complications that we might face during the operation. It was expected that the surgery would take about 12 hours, but it was completed within 10 continuous hours of work by an integrated medical team of all specialties. It was decided to perform the operation on the twins in the fourth month after birth, because it is the appropriate time for such operations (preferably between the ages of 4 months and 6 months).


During his speech at the conference, Yunus recalled the period that preceded the surgery, which took, as he says, “4 months before it was performed, because it is a delicate and difficult operation. Indeed, the birth took place without any complications, and the conjoined twins were transferred to the neonatal intensive care unit, and their condition was stable. We formed a team of Doctors and nurses follow up the twins from birth until after the operation, and it consists of a neurosurgeon, a dermatologist, a radiologist, intensive care physicians, anesthesiologists and nurses… Today, the twins can breathe on their own without the oxygen machine, and we will start feeding them.”

Yunus points out that “this integrated homogeneity between the medical team culminated in the success of this operation, as all details and possibilities were discussed, and this is what made this achievement possible and existing.”

Surgery details

The head of the surgery department at the American University Hospital, Dr. Jamal Hoballah, explained, “The medical team consisted of 5 surgeons with specialists from various fields to keep pace with the process of separating the twins in a way that does not affect the organs that will be separated and affect their lives in the future. We used all capabilities starting with The design of the wound incision and its restoration with the head of the dermatology department, Dr. Amir Al-Amin, who performed the first part of the operation.In the other section, the challenge was in separating the pelvis, which is the area of ​​​​adhesion of the twins, and Dr. Hussein Darwish and Dr. Marwan Najjar, head of the neurosurgery department, took over the task of separating the spine at the bottom With the pelvis, separating the spinal cord and fixing the membrane to avoid any problems or infections in the meninges.

In addition, we needed to separate the reproductive and digestive systems, especially the colon and rectum, and this section is very sensitive and depends on the surgeon’s ability to preserve and control all the muscles responsible for the function of the outlet.”

And God’s love confirms that “Lebanon is still a pioneer in the medical field, and we are still the Orient Hospital, and we thank the Minister of Health’s confidence for the completion and completion of this wonderful work.”

A story of hope

In the midst of the raging collapse wracking the country, we need a glimmer of hope, a small light that illuminates this long dark tunnel. Today, the Minister of Health had good news to announce to the Lebanese, and as he confirmed in his press conference at the American University Hospital in Beirut, “Today we have news and a beautiful story to tell the Lebanese amid these difficult circumstances that we are going through. The story began 6 months ago, when the family of the twins we are in contact with me Announcing the achievement related to it. An ultrasound scan showed that the twins are conjoined inside the mother’s womb, and the call was to discuss the possibility of the mother traveling abroad to perform the separation operation and receive the necessary medical care.”

We acknowledge that these operations are very delicate and difficult and require a medical team consisting of 15-20 specialists, including a surgeon, an anesthesiologist, a neonatal care doctor, and an obstetrician… in addition to the nursing and ambulatory team, and that all members of this team should have immediate and permanent coordination.

Lebanon Orient Hospital

The challenge, according to Al-Abyad, was the possibility of performing this surgery in Lebanon, especially in the difficult conditions and circumstances the country is going through, and the lack of medical supplies, medicines, and medical and nursing staff. Accordingly, I contacted the American University of Beirut and informed them about the medical condition. The question was, “Can the hospital perform this operation and provide this medical service to the mother and the fetuses? The answer was affirmative.”

Thus began the challenge. For the Ministry of Health, the issue was not only related to the American University Hospital, but also to the health and hospital system in Lebanon. As everyone knows, Lebanon was the Orient Hospital, and we were leading the region with medical service. The most important question was: Has Lebanon lost this status and can hospital institutions still provide this type of service?

Al-Abyadh expresses his happiness at what Lebanon and the American University of Beirut Hospital have accomplished, “The answer came with the success of the first twin-separation operation in Lebanon, and this confirms that Lebanese hospitals are still able to be in the first row in providing advanced health care. Therefore, we are happy that Rahaf Reem and their mother are in good health, thanks to the excellent service they received at the American University Hospital.As Minister of Health, I am happy that the health system in Lebanon, although it faces many difficulties, is flexible and has the ability to present achievements, the latest of which is today’s achievement.”

trust fiduciary

For his part, AUB President Dr. Fadlo Khuri said, “What I learned at the university and during my work is that there are two things that, if we lose them, cannot be compensated, namely hope and health. The university has never hesitated to offer hope to all Lebanese without discrimination. Today, we are proud With what the medical team achieved from the moment of birth up to the delicate separation process, and I thank every person who contributed to the success of this operation, and I extend special thanks to the Minister of Health who gave us this confidence and hope to assume this responsibility.

We hope to increase hope for the Lebanese in a better future, and we hope that this hope will give confidence that Lebanon and its people have a much better future than they imagined during the difficult past years.



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