Surgical separation of shared liver with cotton tourniquets in conjoined twins: simple and effective hemostasis

ObjectiveSurgical separation of the fused liver is extremely risky and sometimes life-threatening in conjoined twins because of the potential risks of hypovolemia and hemorrhagic shock.MethodsThree pairs of symmetrical conjoined twins sharing fused livers were successfully separated by using a simple but effective local blockade measure without disturbing the portal circulation.ResultsThe volume of intraoperative blood loss was minimal, and no major complications occurred. All the separated babies survived the procedure and remained healthy, both physically and mentally, after discharge. Two babies died of pneumonia associated with their preexisting cardiac defects.ConclusionsCotton tourniquets temporally and securely blocked the local blood supply to the narrow gap dissecting interface with minimal interference with the remaining segments, in addition to orienting the transection of the fused liver and minimizing blood loss from the liver dissection.