Conjoined twin separation underway at Stanford

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Twins Angelica and Angelina Sabuco are currently undergoing a conjoined twin separation surgery at Stanford, having begun the procedure at 6 a.m. west-coast time. The twins are joined from the front of the torso, and their liver is fused, making the surgery even more difficult than it would normally be.

Conjoined twins are often attached in places where they share vital body parts, such as the brain or the spine. They sometimes share these body parts, which makes it difficult for surgeons to figure out how to separate them.

One of the most famous cases of conjoined twins who shared body parts is the case of Mackenzie and Macey Garrison. The girls, who are now 9, were given up for adoption at birth, along with their twin sister, Madeline. The girls were born attached at the stomach and hips, with one third leg shared between them. They also had entwined intestines, which would make the separation difficult. They were adopted prior to the surgery by Darla and Jeff Garrison, who already had three boys of their own.

The girls were separated in 2003, with a complicated operation that involved removing the third leg and separating the girls’ intestines. The surgery took 24 hours.

Other notable conjoined twin separations have been documented in the media, though many of the conjoined twins have come from other countries. Maria Teresa and Maria de Jesus Quiej Alvarez were joined at the head when they were born and underwent a 23-hour surgery to separate them in 2002. Both girls have prolonged medical issues. One of the girls was left without the ability to speak after she contracted meningitis after she returned to Guatemala after the surgery. In the Guatemalan twins’ case, their chances for survival were much higher because they each had a brain, but the part of the skull that was conjoined had to be rebuilt in each girl’s case, making it a difficult one.

Conjoined twins are rare, which is why many medical professionals think they’re such a fascination to the public. The occurrence of conjoined twins is about one live birth in every 2.5 million live births. When they do survive the birthing process, which is rare, they rarely live past their first birthday.

Without the surgery they are receiving today, conjoined twins Angelica and Angelina would live with many medical problems, including curved spines and muscle problems. The girls are 2 years old and have already survived past the age of 1 that many conjoined twins don’t.

The girls’ mother said they are extremely close; when Angelica coughs, Angelina pats her back. But their mother said she looks forward to an independent life for each of her girls, complete with going to school and having a promising future.

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The minimum amount of time the operation could take is nine hours, say the operating surgeons. They’ll need one hour for preparation, six hours to physically separate the girls surgically and two to three hours that will be focused on reconstruction.

The family is from the Philippines, and the girls’ physical condition has become harder and harder on their mother, who must carry them because a stroller won’t fit the two girls. There are many challenges to raising conjoined twins if parents do not choose to separate them, including the ones the Sabuco mom outlined. All conjoined twins come from one egg that splits, meaning that all conjoined twins are same-sex and identical.

Eng and Chang Bunker were one of the most famous sets of conjoined twins who stayed conjoined and lived full lives until they died within hours of each other at the age of 62. They lived in the 1800s, being born in 1811. The Bunker twins fathered 21 children, despite being conjoined. They were successful businessmen and ranchers in North Carolina, and, rather strangely, were attached by a five-inch connecting ligament near their breastbones. Most conjoined twins are not connected this way but rather more fully fused. After their deaths, it was determined that they could have been successfully separated, but that option was never offered to the twins during their lives.

According to a book written on the subject, titled Entwined Lives, there have been more than 200 attempted surgical separations of conjoined twins since the 1950s, with almost three quarters of those operations being successful and either one or both of the twins living.

The Sabuca family found surgeon Gary Hartman through an Internet search, not wanting to have the girls separated in their native country. Hartman has done one other conjoined twin separation with a pair of girls who were separated in 2007.

The Sabuca girls have a fighting chance because the only vital organ in their bodies that is fused together is the liver. They have two separate hearts, two separate digestive systems and two separate sets of ribs. Anesthesia is a problem, along with their livers, because they have to have to separate sets of anesthetic systems, leaving less room in the operating room for the surgical tools the medical professionals need.

Surgeon Hartman will make the first incisions into their torsos and plastic surgeon Peter Lorenz will cut their rib bones in a way that will allow them to be separated. The girls’ diaphragms and livers will then be separated and the doctors will hope for no surprises once the girls are cut open. The girls will then be moved to separate operating rooms for reconstructive surgery. The girls will recover in intensive care for four or five days and will then be moved to regular rooms, where it is expected they’ll stay a week to finish recovery. Afterward, they’ll go home. The doctors don’t expect much healing time.

The girls’ mother is now left to appreciate the problem that most mothers of multiples have.

"It will be another adjustment again," said mother Ginady. "When one goes somewhere and the other goes somewhere, which one will I get?"

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