An Indian toddler, Lakshmi Tatma, 2, born with a rare condition called isciopagus, which is where a child is born with four arms and four legs, was recovering in the intensive care unit early Wednesday (November 7, 2007) after surgeons in the southern city of Bangalore, India successfully completed a mammoth 27-hour operation to remove her “parasitic twin,” head surgeon Dr. Sharan Patil said.
Speaking to reporters, Patil said Lakshmi Tatma is being monitored closely after a team of some 30 surgeons removed her four additional limbs, she is “stable and sound.”
The operation was conducted by specialists in pediatrics, neurosurgery, orthopedics and plastic surgery. Without it, doctors say, Lakshmi would be unlikely to survive beyond early adolescence.
“Every step of it was successful,” Patil said of the operation. “There was no set back what so ever. The team worked through the night relentlessly.”
Later in the day the girl’s parents were slated to visit her, he said.
The task began early Tuesday and went through the night, with surgeons working eight-hour shifts.
The conjoined twin stopped developing in the mother’s womb, and has a torso and limbs, but no head. It was joined to Lakshmi at the pelvis.
When Lakshmi was born into a poor, rural Indian family, villagers in the remote settlement of Rampur Kodar Katti in the northern state of Bihar believed she was sacred. As news of her birth spread, locals queued for a blessing from the baby.
Her parents, Shambhu and Poonam Tatma, named the girl after the Hindu goddess of wealth who has four arms. However, they were forced to keep her in hiding after they were approached by men offering money in exchange for putting their daughter in a circus.
The couple, who earn just $1 a day as casual laborers, wanted her to have the operation but were unable to pay for the rare procedure, which has never before been performed in India.
After Patil visited the girl in her village from Narayana Health City hospital in Bangalore, the hospital’s foundation agreed to fund the $200,000 operation.
Planning for the surgery took a month, Patil said, and Lakshmi spent that month in the hospital.
“We are quite optimistic,” “We expect that she should be able to walk normally and lead a normal life.”
Many villagers, however, remain opposed to surgery and are planning to erect a temple to Lakshmi, who they still revere as sacred.
Patil said Lakshmi’s parents are “very practical” and knew the risks of the medical treatment. Asked about the belief she is a reincarnation of the goddess, he said, “She’s a very charming young girl, and I’m sure she’ll grow up and be something special.”
UDATE AFTER SURGERY: LAKSHMI WLAKS AND GOES TO SCHOOL
She was born with a unique body – eight limbs and two torsos fused at the hips.
Now Lakshmi Tatma, the Indian toddler whose plight touched the world, has grown up and started school.
Two years after a ground-breaking operation to separate her from a parasitic twin, Lakshmi is a lively and bubbly four-year-old.
She loves playing cricket with her older brother, has a tendency to boss around her newfound friends and remains firmly a daddy’s girl.
‘When I think of the way she was, never in a million years would Lakshmi have been able to go to school or have the life she does today,’ said her mother Poonam, 26.
‘All the things she’s capable of now were impossible two years ago.
‘I often try to think what she might be like today if she hadn’t had the operation – she couldn’t even sit up before and now she runs around like other children.’
Born in a dusty farming village in India’s poorest state, Lakshmi was revered as a deity and worshipped from birth.
Villagers, who believed she was the reincarnation of the Hindu goddess of wealth and fertility, would seek her blessing daily and leave gifts at her bedside.
But Lakshmi’s resemblance to her mythological namesake came at a terrible price. She could not walk, stand, or even sit.
The little girl was joined to a headless parasitic twin that had stopped developing in her mother’s womb. Doctors were convinced she could not have survived into adulthood.
Now fully recovered from the 27-hour operation to save her, Lakshmi is almost unrecognisable from her former self.
Beneath the surface, however, lurk a series of medical problems that threaten her future and will require years of surgery.
Six months after the complex operation to remove Lakshmi’s parasitic twin, doctors discovered she had developed scoliosis, or a curvature of the spine.
Without a complex operation to correct her spine doctors have warned her back will be forced into increasingly severe deformities as she grows, possibly leaving her disabled.
Separately, Lakshmi requires an operation to ‘detether’ her spine after it was discovered she was born with abnormal tissue connecting the spinal cord to her nervous system.
In a further operation orthopaedic surgeons must perform a procedure to ‘close her hips’, which are set too far apart and result in an unusual ‘gaited’ walk.
Finally, plastic surgeons will need to find a way to create buttocks for Lakshmi, which did not form in the womb because of the unique way she was connected to her parasitic twin. In the same operation surgeons will have to fix related problems with her bladder and intestines.
‘Lakshmi has come such a long, long way but we’re very scared for the future,’ said her mother Poonam.
‘At one time we never imagined she would look so healthy, so we are very grateful for all the help we’ve had.
‘But we can’t bear the thought that all this help could be undone if we can’t find a way to get the extra operations she needs.
‘The charity that looks after her cares for 500 other children as well. It does not have the funds to pay for these operations and we have no money either.
‘The hospital that operated on her before has promised to help but they cannot correct her spine because it is such a specialised operation.
‘All we want is for her to be a normal child. She has had her operation but even now she can’t walk or move normally. Her feet don’t come together properly and when she walks it hurts.’
Despite the threat to her future, Lakshmi’s life today is a world away from the circumstances of her birth.
Born to impoverished parents in the frequently lawless state of Bihar, in India’s volatile northeast, Lakshmi faced an uncertain future until a wealthy doctor heard of her plight and offered to operate on her for free.
Orthopaedic surgeon Dr Sharan Patil, owner of the Sparsh Hospital in Bangalore 2,000 miles south, travelled to Lakshmi’s remote village in 2007 to meet the child and offer her parents the chance of a lifetime.
After more than a month planning the separation, Dr Patil’s team attempted the first operation of its kind in the world.
Hundreds of journalists camped outside the hospital throughout the 27-hour surgery.
Lakshmi’s fame, having spread from her tiny village around the world, prompted Sucheta Kriplani Shiksha Niketan (SKSN), a charitable school looking after disabled children in the desert state of Rajasthan, to offer her parents a place to live and the chance of an education for Lakshmi and her brother Mithilesh.
Dr Bhairoon Singh Bhati, the secretary of SKSN, said: ‘Lakshmi is a special case for us. She’s a very challenging case because you can never tell from her medical history when she might next fall ill.
‘Her scoliosis is an example of the problems Lakshmi faces because we had no way of knowing she would develop a curvature of the spine.
‘Similarly, despite all the problems she still faces we have no way of knowing what may crop up in the future.
‘The biggest difficulty caring for Lakshmi is that she’s a unique case – there’s never been a child like her before so we have nothing to refer back to.’
Under Dr Bhati’s guidance Lakshmi has started school, joining her elder brother as the only members of their family to ever receive an education.
Her father Shambu, 28, said: ‘I believe with all my heart that Lakshmi is indeed a goddess. The operation removed her extra legs so that she can lead a normal life but she is not a normal child.
‘She’s special, I think anything is possible for her. I’d like her to be educated so she can become a teacher. Then she can pass on what she knows to other children.’
Frontiers in Neuroscience 