Oldest Daily Newspaper in the .United Stat~hunded 1771 ~--_- Thursday, September 19, 1974 TWO fj'-month-old Siamese twins were success- fflll)~ separnted irz a rare, 10f2-km'-long operation at Ch.ildren's Hosp~rnl Ilfedncsday. Tke past wceiis kove keen kard on them and their mother. Were is tkcir story. Dr. C. Everett Koop, chief surgeon At first gl:~nCe there didn't stem to be anything wrong \vith the tlvo little girls \vhn were playing games lfsith each other Tuesday --morning in the crib bed at Chil- dren's Hospital. They were obviously happy. The color in their faces. was good. And they certainly were active. But there was something terribly wrong. They were Siamese twins. They had been li!*ing attached to each to other since their birth in San Jose, Dominican Republic, a lit- tle over a year ago. Joined together at the loser trunk and pelvis, they looked as if they were sitting in each other's lap. But neither could and only one could sit up at a time, a cause of considerable consternation to them when they bath \tmtcd to sit at the same time. 111 ICSS than 21 hours, the babies n~ould be rvheeled down the corridor to an operating room, put t&a sleep \!ith ancsthexln and separated by a team of 1.3 doctors and nurses that had been assembled for the unusual operation. Sian&_ tVwins occur only on& .&' 69,000 births, when the *f&tilized egg doesn't di- vide comljletely as it nor- m&. does: in twin concep- tiqn$.-Most 5iamese twins are stillboti. A -few are born alive but share a+single vital organ like a I h$t, :>makiqg separ$iok itipoksible with& sacriiicihgcqnk of'eem. Other tin&; they ake joined Bt the head anh separation is impos- sible. ' / $ortunately for these two babies,. they weire johidd at the' &.$men and pel% The o&T organ they shared was the jive;, and each of the ba- bies :`prqvided her own blood ~ s~p$jr to _th$ organ, making it &~iQfe. io. cut tbe liver in bau; #kg one part ,to each b&x&: which would be more thah &@gh to sustain life, _5 I - Ir'are burgery Living Siamese twins are so rare that the last operation of this type ir, Philadelphia was performed eight years ago, at St. Christopher's Hospital for Chil&en. Children's Hospital had not been used for one since 1957. The babies' mother, Mrs. Farida, Moris de Rodriguez, looked _ tired and frightened Tuesday when she visited the hospital. She didn't speak English and she was terrified by the big city of Philadel- phia. and by the strange ma: chines and electronic devices that were being used on her babies. Since she is the wife of a farmer, she knew nothing of such things. Her one-acre farm does not even have elec- tricity, and the nearest city of any size is Santo Domingo, a three-hour ride away. They live off the farm produce and the money it brings from the rnadside vegetable stand they run. The last year had been a difficult one for her. When her Siamese Wins, Clara and Altagricia, were born ,4ug. 12, her doctor told her that the babies probabiy would die in a few months and that noth- mg could he done. Another noctor She took the babies home to die. Instead, they hecarne healthier and stronger. Another doctor was con- sulted. He told her that the twins possibly could live 10 adulthood, but that it wou!d be impossible to divide them. Llrs. Rodriguez resigned herself to a wretched fate. But fortunately, word of her plight was passed to Mrs. Ro-, driguez's cousin, , who men- tinned it to the woman she worked for in Puerto Rico, \vho 111 turn told her, sister, Xlrs. Diana Zlmnoch in \Yar-' rington. LIrs. Zimnoch called Children's Hospital. A fern months later, a !.cr): frightened noman, her Sla- mese twin< clutched in her arms, boarded a jet for fhila- delphia, a tit!, she had never heard of that had a hospital) that might be able to do something for her habies. With little money of her own, Mrs. Rodriguez had oh- tained the air fare from Mrs. 23imnoch's church. the Com- munity Christ Church in \\`ar- rington, which raised the funds.' Children's Hospital do- liver and then worked On the nated the medical care. bladder and intestines. The ureters leading to the Diffi&t Day bladders crossed between the Mrs. Rodriguez last saw two babies, so they had to be severed and resewn. Because her daughters joined tW3h' the babies had only one rec- Tuesday. She put them on tum, Dr. Koop was afraid her lap in a &king chair hl that he would have to per- the pediatric unit, combed form a colostomy on Alta, their hair and kissed them goodbye. pushing the colon (large in- testine) through the wall of Wednesday would be a diffi- the abdomen. cult day for her. But the surgeons were in She couldn't bear to go to luck. Not only was there the hospital. Instead, she enough colon to enable him to would wait by the phone at make an artificial rectum Mrs. Zimnoch's h o u se in and put it in the normal Warrington, where she had place, but he also was able to been staying with the promise insert it through a muscle of getting bulletins from the mass so that Alta would have operating room at two-hour some control over her bowel intervals. When it was over functions. she would cable her husband The operation was moving and five other children in the rapidly when Dr. Stanley Dominican Republic. Chung, an orthopedic sur- The babies were taken to gem ami Dr. John W. Duck- the ooerating room at 6115 ett Jr., a urologist, joined the Wed&day morning. .team. Simultaneously, two of the six anesthesiologists who would be working in the oper- ating room placed a face mask over each baby's mouth and the twins were put to sleep. The operating room began filling with people. The babies were propped up on the foam wedges, each sitting on differ- ent operating tables that had been pushed together. As soon as separation was achieved, the two tables and babies would be pulled a few feet apart so surgeons would have more room to work on each child. First Cut It took more than three hours to hook four monitoring and drug lines into the blood vessels of each baby and put tubes down their throats be- cause it was so awkward to work on them joined together. Sot until 1O:lS did Dr. C. Ev- erett Koop, the surgeon-in- chief at Children's and the senior physician on this case, make the first cut. Gloving swiftly, he and Dr. Louise ichnaufer cut through !hP Illtl'l ;kin. divided the Babies Separated Using a circular hand saw. the surgeons cut through the pelvis and finally, with an electrical scalpel that cuts and cauterizes tissue at the same time, they severed the remaining skin that joined the two babies. It was lo:37 A. M., a little more than four hours since the operation began. A call was placed to Mrs. Rodri- guez. Her twins had been se- parated, she was told, and things were going much better than had been expected. But much still had to be done. A principal problem was to ' close the gaping hole in the abdomens where both infants had been joined by a limited amount of tissue. Clara had m&e than enough extra flesh, so they easily closed the wound and sent her to the recovery room. She would have to un- dergo a second operation in about two weeks because sur- geons would need to break her pelvis in two places to get the hip joints into the proper place for walking. But they d.id not want to keep her on the operating table any more now. It had been a hard day for the baby. Problem Solved But there wasn't enough skin to close the hole in Alta's abdomen, so the surgeons broke her pelvis in two places and bent it from a C-shape into the circle it was sup- posed to be. Not only did this enable them to close the hole with the avaiiable tissue, but it got her hip joints into the right position for walking. The operation ended at 4:40 P. M. Dr. Koop declared it a com- plete success. In the future, the twins will need minor surgery to iet rid of a tissue wall that split their two vaginas into four. Alta's rectum and vagina are side by side, but as she grdws older they should move to the normal front-back posi- tion. To' help the wounds heal. the doctors minimized the amount of abdominal move- ment by paralyzing the babies' muscles *with a drug and at- tached the babies to ma- chines that will breathe for them. The. machines should be needed for about two days. Sephrate Liyqs There probably will be psy- chological problems. But no one can predict how a baby will react to living the life of an individual, sepa- rate person after being joined to another person for 13 months. Mrs. Rodriguez hopes to re- turn to the Dominican Repub lit in a few days, because she feels she can't leave her fam- ily of six alone any longer. If money can be raised to bridg her back in a month or two when the twins' recupera- tion is completed, she will re- turn ,to' Philadelphia and to take them home. If not, some other arrange- ment will be made. But Wednesday no one was worrying about such things.