2-year-old conjoined twins prepare for dangerous separation surgery

Nov 2 2011 - 12:04am

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Angelica Sabuco (right) and her twin sister Angelina draw on paper with the help of their mother, Ginady Sabuco, at the Lucile Packard Children's Hospital on Monday in Stanford, Calif. The hospital is preparing for surgical procedure to separate the 2-year-old girls who were born joined at the chest and abdomen. (Marcio Jose Sanchez/The Associated Press)
Angelica Sabuco (left) and her twin sister, Angelina, sit in the lap of their mother, Ginady Sabuco, as they are brought in for a meeting with the media at the Lucile Packard Children's Hospital on Monday in Stanford, Calif. The hospital is preparing for surgical procedure to separate the 2-year-old girls, who were born joined at the chest and abdomen. (Marcio Jose Sanchez/The Associated Press)
Angelica Sabuco (right) and her twin sister Angelina draw on paper with the help of their mother, Ginady Sabuco, at the Lucile Packard Children's Hospital on Monday in Stanford, Calif. The hospital is preparing for surgical procedure to separate the 2-year-old girls who were born joined at the chest and abdomen. (Marcio Jose Sanchez/The Associated Press)
Angelica Sabuco (left) and her twin sister, Angelina, sit in the lap of their mother, Ginady Sabuco, as they are brought in for a meeting with the media at the Lucile Packard Children's Hospital on Monday in Stanford, Calif. The hospital is preparing for surgical procedure to separate the 2-year-old girls, who were born joined at the chest and abdomen. (Marcio Jose Sanchez/The Associated Press)

SAN JOSE, Calif. -- Stanford surgeons seek to give two sisters a life apart, dividing their shared bodies into two in a long, delicate and risky surgery.

Without the procedure, San Jose conjoined twins Angelica and Angelina Sabuco -- fused at their liver -- would face a troubled future, with curved spines, muscle problems and the emotional challenges of intimately shared lives.

Tuesday's surgery could give the 2-year-olds, and their family, a chance to lead normal lives.

But the rare procedure poses the threat of massive bleeding or the catastrophic introduction of an air bubble into the venous system, causing heart attack or stroke.

"I have mixed emotions," said the girls' mother, Ginady Sabuco. "But I want them to live normally, like other children."

The operation at Stanford University's Lucile Packard Children's Hospital will take at least nine hours -- an hour of preparation, six hours to cut apart the girls and two to three hours of reconstruction. A team of 20 doctors and nurses will take part in the delicate procedure, which is performed about six times a year in the United States.

The identical twins are strong, with similar almond eyes but distinct personalities.

Angelica is the sturdier and more extroverted one; Angelina is quieter. Like all toddlers, they are curious and stubborn, so need constant supervision to prevent strife.

"When one wants something the other does not, we do not want them to get hurt," said aunt Marie Sabuco.

Both girls love Elmo from the TV show "Sesame Street." They play "mommy and baby" with each other; when Angelica coughs, Angelina gently pats her back. They know the alphabet, their colors and can count to 10.

But their growing weight -- 55 pounds combined -- posed practical problems for mother Ginady, who must carry the girls together. To dress them, she buys identical clothes, cut down the middle and then joined by Velcro.

The family could have sought surgery in their native Philippines, but father Fidel works as a technician at Ultraclean Technologies in Hayward, Calif., and had a good Blue Cross health insurance policy.

An Internet search led them to pediatric surgeon Gary Hartman -- and Stanford. The family petitioned for the mother to come to the United States with the girls.

Conjoined twins are rare, representing between 1 in 50,000 to 1 in 100,000 births. (Accurate numbers are hard to come by, because many die during pregnancy or birth.)

The cause remains a mystery, said Hartman. Either two separate eggs fuse during early development, or a single twinned embryo fails to separate.

This will be the second separation of conjoined twins performed at Stanford. The first pair, also separated by Hartman's team in 2007, is now doing well.

At first, there was no guarantee that Angelina and Angelica would survive surgery.

Happily, internal imaging showed that the girls have separate hearts, making surgery feasible. There was another piece of good news: their digestive systems function independently. And although their sternums are joined, their ribs are separate.

But their livers are tightly fused together. This is worrisome, because a healthy liver is critical to survival -- it removes toxic chemicals and makes the bile needed to break down food.

Anesthesia poses another challenge. Although they are viewed as individual patients, with separate respiratory systems, there is little room to accommodate all the tubes and other tools essential to keep airways open.

Hartman will make the first incisions in the girls' skin and muscle, and plastic surgeon Peter Lorenz will cut through their rib bones.

The doctors are hoping that the girls' bodies, once opened, will reveal no surprises.

Their girls' diaphragms and livers will be divided. Finally, Hartman will cut any adhesions between the girls' bowels, as well as any last bit of shared skin.

Then, in separate operating rooms, the reconstruction phase will begin. To rebuild the girls' chest and abdominal walls, doctors will implant a thick resorbable plate into each girl.

Afterward, the girls will be in intensive care, where they'll recover for four to five days before being moved to a regular room for another week or so.

Then they'll head home to San Jose to start their lives as two ordinary little girls.

"I want them to have a good future," Ginady Sabuco said.

(c)2011 the San Jose Mercury News (San Jose, Calif.)

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