Chilean Doctors Separate Conjoined Twins

By: AP Email
By: AP Email

SANTIAGO, Chile (AP) - Chilean doctors successfully separated
conjoined twin girls in a marathon 20-hour surgery, saying
Wednesday that the operation went extremely well despite
challenges.

The 10-month-old twins Maria Paz and Maria Jose were recovering
in an intensive care unit, and doctors said the next two days would
be critical as they watch for infections or other possible
complications.

Parents Jessica Navarrete and Roberto Paredes kept an anxious
vigil at Luis Calvo Mackenna Hospital in Santiago as doctors
separated the twins at the thorax, abdomen and pelvis. It was the
seventh and most complex operation yet for the twins.

Doctors successfully separated the twins late Tuesday night.
Chief surgeon Francisco Ossandon described it as the moment "the
girls finished the process of being born."

"Before, they had two souls and one body," Ossandon said.

Surgery on one of the twins was completed early Wednesday after
a total of 19 hours, while for the other it took more than 20
hours.

"We had a number of difficulties during the surgery. There were
some surprises, but we were able to fix, solve the problems,"
Ossandon said at a news conference.

He added that the twins came out of the surgery in good
condition. Ossandon, however, didn't rule out future complications
involving the effects from anesthesia and possible infections.

"We're very happy because we think they've had the best
evolution we could have hoped for," he said.

The girls' parents appeared in televised images as they kissed
the twins before the operation. Then afterward, the mother and
father gazed lovingly at the sleeping girls from beside their
separate cribs in the intensive care unit.

Paredes softly placed a hand on one daughter's head.

Some Chilean television stations occasionally broke into their
regular programming to broadcast updates from the doctors, both
during and after the delicate surgery.

"The next 48 hours will be the most critical in terms of the
... risk they face of dying," said Dr. Carlos Acuna, chief of the
intensive care unit. He said the girls faced risks of various
organs ceasing to function, and also had kidney and lung problems.

The girls' mother said she was hoping for a miracle when the
high-risk operation began Tuesday morning.

The Chilean twins presented a particularly difficult challenge
because they were born sharing many of the same internal organs and even urinary system. About 100 people participated in the
procedure, including 25 surgeons and anesthesiologists.

Perhaps providing some comfort to the parents was the hospital's
history with conjoined twins. Staff there have separated three sets
before. A fourth set, however, died during surgery due to cardiac
complications.

According to the University of Maryland Medical Center, roughly
one out of every 200,000 live births worldwide results in conjoined
twins. The overall survival rate is between 5 percent to 25
percent, depending on various factors, including where they are
joined.

While rare, such surgeries have become increasingly frequent
over the years due to improvements in surgery, anesthesia and
critical care, said Dr. Eric Strauch, a surgeon at the University
of Maryland Medical Center.

"We've gotten better at dealing with them," Strauch said. "I
think people are willing to undertake it more."

He said he has performed surgeries on two sets of twins. The
first set, girls from Uganda, survived in 2002 and are now about 10
years old, he said.

"The second set survived for about six months after the
separation, but they both succumbed to infection," said Strauch,
adding that their intestines were unable to function.

He said he knew of another successful case in which two girls
were separated and have reached adulthood.

"They're in their 20s and they're just graduated from college," Strauch said. "A lot of them don't do well, but a lot of them do."

Dr. Steven Fishman, a pediatric surgeon at Children's Hospital
Boston, said that if twins make it out of the hospital without
post-surgery complications, most tend to survive.

"If they're felt to be well enough to go home, in general they
will make it long term," he said.

The Chilean twins were born in the Villarrica hospital about 470
miles (760 kilometers) south of Santiago and were kept under
constant medical care, surviving with the aid of an artificial
respirator.

Earlier this year, doctors separated the twins' legs, urinary
tracts, pulmonary systems and other parts of their bodies. They now
each have part of a leg that used to be fused together.

During the latest surgery, doctors managed to separate an
intestine that had been shared by the two, giving each of them part
of it, said Jaime Manalich, the government's health minister, who
visited the family at the hospital.

Surgeons weren't able to completely close their abdominal
cavities or their thoraxes, and therefore had to use meshing to
cover them, Ossandon said. "These are foreign bodies that
sometimes the body recognizes as foreign, and that can cause
infections," he said.

Maria Jose was the first twin to reach the intensive care unit
after the surgery. Her sister Maria Paz, whose operation was more
complex due to difficulties in the area near her heart, arrived an
hour and 15 minutes later.

They were born in February, and since then have been
hospitalized and attached to machines including an artificial
respirator.

The girls were still connected to a respirator on Wednesday.

They are to remain sedated for at least three days.

Ossandon said the twins will return to the operating room every
two or three days so that doctors can clean their wounds. He called
the surgery their "rebirth."


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