Texas hospital successfully separates conjoined baby girls in 'marathon' procedure

Date: Feb-25-2015Despite sharing several organ systems, 10-month-old conjoined twins Knatalye

Hope and Adeline Faith Mata were successfully separated in a world-first marathon

procedure that was carried out at Texas Children's Hospital in Houston on February 17th.

John Eric and Elysse Mata embrace their daughters before they undergo the lengthy, complex and successful separation.
Image credit: Allen Kramer and Paul Kuntz/Texas Children's

The twins were estimated to weigh just 3 lb 7 oz each when they were born by

Cesarean section at 31 weeks of gestation at Texas Children's Pavilion for Women in

April 2014.

It was during a routine ultrasound 3 months earlier that the family - parents

Elysse and John Eric Mata, and 5-year-old brother Azariah - learned not only that

Mrs. Mata was carrying twins, but also that they were conjoined.

After this, they were referred to Texas Children's Fetal Center at the Children's

Hospital for extensive prenatal scans and multidisciplinary consultation. Hospital

teams also developed plans to ensure safe delivery and postnatal care of the

twins.

Twins shared several organ systems

As the pregnancy ensued, scans and tests revealed the baby girls shared a chest

wall, pericardial sac (the lining of the heart), lungs, diaphragm, liver,

intestines, colon and pelvis.

To deal with such a complex separation, various specialists were

required, including pediatric surgeons, plastic surgeons, heart surgeons,

urologists, plus surgeons specializing in liver transplant, orthopedics and

pediatric gynecology.

During the marathon procedure, the team of 26 surgeons, anesthesiologists,

surgical nurses and others, worked for 23 hours on Knatalye and 26 hours on Adeline.

The twins were officially separated 18 hours into the operation.

The separation surgery marks the culmination of months of preparation involving

13 different specialties in the care of the twins, as lead surgeon Darrell Cass, a

pediatric surgeon and co-director of Texas Children's Fetal Center, and associate

professor of surgery, pediatrics and obstetrics and gynecology at Baylor College of

Medicine, explains:

"This is the first time a separation surgery for thoraco-omphalo-ischiopagus twins with this particular configuration has been successful.

This surgery was not without its challenges with the girls sharing several organ

systems. Our team has been preparing for this surgery for months and we've done

everything from working with our radiology experts to build a 3D model of their

organs, to conducting simulations of the actual separation

surgery."

In order to prepare for their separation surgery, the twins underwent a 5-hour

operation in December 2014 where surgeons inserted tissue expanders into their chest

and abdomen area to stretch their skin.

The twins are now in the Pediatric Intensive Care Unit of the hospital under the

care of a multidisciplinary team as they recover over the next

two months.

Doctors say the twins will have to undergo further surgery in the future. It is

too early to say when they will be discharged.

The following video gives the hospital's account of the historical separation

surgery.

Mrs. Mata says she and her family are very grateful for the enormous amount of planning and time

that went into the surgery, and to the teams who cared for Knatalye and Adeline and

who have given them "the incredible chance to live separate lives."

She also wished to thank all the people who have supported the family with their

hopes and prayers over the last 10 months.

Conjoined twin girls have a better survival rate than boys

Births of conjoined twins are rare, occurring around once every 200,000 live

births. Many conjoined twins are stillborn or die within 24 hours of birth. The

overall survival rate is thought to be between 5% and 25%.

For some reason, conjoined twin girls seem to have a better survival rate than

boys, despite the fact that more male conjoined twins form in the womb.

Conjoined twins are genetically identical, and so always the same sex. Like all

identical twins, they develop from the same fertilized egg, and they share the same

amniotic cavity and placenta.

Conjoining is the result of the single egg not separating properly after

fertilization. The developing embryo begins to split into identical twins during the

first few weeks after conception but stops before the process is complete.

There are several types of conjoined twins, depending on the part of the body

where they are fused and joined.

Attempts to separate conjoined twins are risky and complex and very rare - which

is why they so often receive worldwide media interest.

In 2011, Medical News Today reported another marathon separation

procedure where 19-month conjoined twins Maria and

Teresa Tapia from the Dominican Republic were successfully separated following a

20-hour operation involving a team of 45 health professionals.

Written by Catharine Paddock PhD

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.