SINGAPORE, July 7: Conjoined Iranian twin sisters will endure longer surgery than expected to separate their fused brains after a risky bypass led doctors to struggle against unstable blood circulation between them early on Tuesday.

Neurosurgeons were still in the very early stages of the delicate process to split apart their fused brains, said Dr Prem Kumar Nair, a spokesman for Singapore’s Raffles Hospital where the operation was under way.

The 29-year-old twins Laleh and Ladan Bijani, who are joined at the head but have anatomically separate brains, began the life-threatening operation to separate them at midday on Sunday.

“As we have found with the skull bones, the two brains have been found to be very adherent to each other,” Nair said, which has slowed the second part of the brain separation surgery.

“Although the brains are distinctly separate, because they have been fused for the last 29 years they are very adherent to each other. Dissection to separate them is thus taking a long time,” he told a news conference late on Monday.

Nair said another complication was that after completing a bypass for Ladan, with the vein fashioned from her own right thigh, blood circulation between the twins was unstable.

After the skulls were opened, surgeons had begun creating a bypass. This vein is used to duplicate a shared major blood vessel between the two brains so the skull can be split.

The second stage of the operation, after the craniotomy or opening up the women’s combined skulls, involves severing blood vessels and veins around their brains.

The latest stage started at 5 p.m. (0900 GMT) and had been scheduled for completion in 10 hours.

Nair said the team of neurosurgeons had to cut carefully through the sisters’ brain tissue millimetre by millimetre.

“It’s just an indication of how careful the team wants to be with the separation. If it takes a bit longer I think we shouldn’t be too worried about it.”

He gave no details how much longer the brain separation surgery would take.

The first stage of the operation had already taken longer than expected because the bone where the twins are joined was thick and compact.

Asked if the bypass was the riskiest part of the operation for the five neurosurgeons, Nair said other hurdles lay ahead.

“That was one tough part of the surgery, the other tough part is the actual separation of the brain. At the end of the day we are trying to achieve separation,” he said.

“The process that is now being undertaken by the neurosurgeons is equally difficult.”

German doctors turned away the twins in 1996, saying splitting them could prove fatal. But the Bijanis were determined to lead separate lives and persuaded Singapore doctors to carry out the surgery, despite the risks.

IRANIAN GOVT TO PAY: The Iranian government will pay the 300,000 dollar bill for the historic operation, an official announced Monday as the sisters endured their second day of surgery to be separated.

The team of more than 100 surgeons and other medical staff had agreed to waive their fees for the operation, which began on Sunday and is expected to last between two and four days.

Raffles Hospital in Singapore, where the surgery is being carried out, had also agreed to underwrite the twins’ stay at the hospital.

But there was still a shortfall of nearly 300,000 dollars for other expenses, such as the use of medical equipment, developing computer images and skull models, as well as medication and expenses that go into post-operative care.

“The Islamic Republic of Iran will cover this whole cost,” Iran’s ambassador to Indonesia, Shaban Shahidi Moadaab, told reporters Monday night after flying to Singapore to assess the operation and deliver the funding pledge.

Moadaab said the decision came directly from Iranian President Mohammed Khatami, who declared on Sunday that his entire country was praying for the twins.

LEGAL CONSIDERATIONS: The surgery currently underway in Singapore to separate conjoined Iranian twins could have been carried out in Iran but was blocked by legal considerations, the governmental paper Iran reported Monday.

Valiollah Mehrabi, a renowned paediatric surgeon in Iran and the physician to twins Ladan and Laleh Bijani, told the daily that all the relevant research had been carried out and consultations made with a German medical team in Heidelberg.

However, eventually legal barriers made the operation impossible.

According to local laws, surgery with a possibly fatal result could be considered as homicide and the surgeon could therefore be arrested on such charges.—Reuters/dpa