Conjoined twins undergo separation surgery in US - Health

& & RICHMOND, Virginia — Conjoined twin girls from the Dominican Republic were recovering Tuesday at a Virginia hospital after undergoing complicated, nearly daylong surgical procedures to separate them.&

Maria and Teresa Tapia were born joined at the lower chest and abdomen, sharing a liver, pancreas and portion of the small intestine.

A team led by Dr. David Lanning, surgeon-in-chief at Children's Hospital of Richmond at Virginia Commonwealth University, completed a 20-hour surgery on Maria and an 18.5-hour surgery on Teresa.

Lanning said at a news conference Tuesday the toddlers were in stable condition in the pediatric intensive care unit, and that he expects the 19-month-olds to fully recover and "grow up to be healthy, young independent girls."

In several procedures involving six surgeons, the medical team divided the liver, pancreas and other shared organ systems and reconstructed the girls' abdominal walls.

"Everything just went so smoothly over the last 24 hours," Lanning said.

The girls and their 24-year-old mother, Lisandra Sanatis, arrived in Richmond about two months ago to prepare for the lengthy, intricate surgery. The twins and their family have become celebrities in the Dominican Republic. The country's first lady, Margarita Cedeno de Fernandez, stopped in Richmond on Monday during the surgery to support them.

Sanatis thanked God, Cedeno de Fernandez, Lanning and many others for helping her daughters, and wept with happiness.

"It was really my dream and thank God it came true," she said through an interpreter.

VCU's first attempt at separating conjoined twins also allowed some of the university's students to use their talents to help the family in unexpected ways.

"It's more than just an operation," said pediatric plastic surgeon Jennifer Rhodes, part of the medical team operating on the twins. "To get patients from start to finish you need to get involved and care for them in a holistic fashion."

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Students from the Department of Fashion Design and Merchandising created new outfits for the toddlers, an occupational therapist modified a car seat, and a sculpture student created foam models of the twins' bodies so Rhodes could practice on synthetic skin before the surgery.

The World Pediatric Project, a nonprofit surgical-care provider for children in Central America and the Caribbean, sponsored the twins' medical care, along with the family's stay in the United States. Lanning has been a surgical volunteer with the group for several years.

Sanatis said she has always dreamed of seeing her daughters as separate and independent children. Teresa is more tranquil and Maria is more forceful and tough, she said.

"It may be a little strange at first, but it really is what I wanted," Sanatis said through an interpreter in an interview before the surgery. "I'm so happy to be able to see them be the individuals they were born to be."

Because of the way the top portion of their small intestines were connected, Maria wasn't able to absorb the nutrition she needed and was about 20 percent smaller than Teresa. Also, nearly 88 percent of the liver's blood flow was routed to Teresa. Lanning the disparities would likely have increased unless they were separated.

Lanning said he had "extensive conversations" about the Tapia case with Dr. Gary Hartman, the pediatric surgeon who led a team at Stanford University that separated twin girls joined at the chest and abdomen last week.

The girls are expected to remain in the hospital for about two weeks and stay in Richmond at least another month so they can undergo physical and occupational therapy, along with follow-up visits with doctors. They could return home by the end of the year to reunite with the twins' father, a construction worker, and three other siblings.

About a half-dozen separation surgeries are done in the U.S. annually, Lanning said, and maybe double that number worldwide.

Worldwide, conjoined twins account for between 1 in 50,000 and 1 in 100,000 live births. The condition is three times more likely to occur among females than males. A third of conjoined twins are attached at the lower chest, as in the case of the Tapia twins.

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Online:

Children's Hospital of Richmond at VCU: http://blogshots.org/www.childrenshosp-richmond.org/CMS/index.php

World Pediatric Project: http://blogshots.org/www.worldpediatricproject.org/

Zinie Chen Sampson can be reached on Twitter: https://www.twitter.com/zinie

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