Conjoined twins undergo separation surgery in Va.

RICHMOND, Va. (AP) - Conjoined twin girls from the Dominican Republic were reported in stable condition Tuesday at a Virginia hospital after undergoing complicated, nearly daylong surgical procedures to separate them.

Maria and Teresa Tapia were born joined at the lower chest and abdomen, sharing a liver, pancreas and portion of the small intestine.

A team led by Dr. David Lanning, surgeon-in-chief at Children's Hospital of Richmond at Virginia Commonwealth University, completed a 20-hour surgery on Maria and an 18.5-hour surgery on Teresa.

Lanning said Tuesday the toddlers were in the pediatric intensive care unit and were in stable condition.

In several procedures involving six surgeons, the medical team divided the liver, pancreas and other shared organs and reconstructed the girls' abdominal walls.

The 19-month-old twins and their family have become celebrities in the Dominican Republic. The country's first lady flew to Richmond to support them. The girls and their 24-year-old mother, Lisandra Sanatis, arrived in Richmond about two months ago to prepare for the lengthy, intricate surgery.

VCU's first attempt at separating conjoined twins also gave an opportunity for VCU students to use their talents to help the family in unexpected ways.
"It's more than just an operation," said pediatric plastic surgeon Jennifer Rhodes, part of the medical team operating on the twins. "To get patients from start to finish you need to get involved and care for them in a holistic fashion." Rhodes helped coordinate some of the projects.

Students from the Department of Fashion Design and Merchandising created new outfits for the toddlers, an occupational therapist modified a car seat so they could go on outings, and a sculpture student created foam models of the twins' bodies so Rhodes could practice on synthetic skin before doing the surgery.

VCU occupational therapist Audrey Kane modified a car seat for Maria and Teresa so they could go on outings around Richmond without having to rely on an ambulance. The seat had no sides so the twins could fit into it, and the harness straps and belt were modified to fit the girls' bodies, said Kane, who has received training on transporting children with special needs.

Four fashion-design majors designed new dresses for the girls, who arrived in the U.S. with summer-weight T-shirts that wouldn't be warm enough in Virginia's fall weather. The students came up with several knit dresses with flared silhouettes to accommodate their shapes as well as a bumblebee Halloween costume.

The project gave the aspiring designers a chance to "use fashion to do something for the community, rather than just giving people fabulous clothes," said senior Megan Murphy. "It's something useful."

Sculpture major Morgan Yacoe integrated art and science in creating molds of the twins' torsos after making wax replicas of their bodies. Yacoe then recast the model in foam and covered it in silicone rubber so that Rhodes could use the model to anticipate surgical scenarios that could occur after the separation.

The World Pediatric Project, a nonprofit surgical-care provider for children in Central America and the Caribbean, sponsored the twins' medical care, along with the family's stay in the United States. Lanning has been a surgical volunteer with the group for several years.

Sanatis said she has always dreamed of seeing her 19-month-old daughters as separate and independent children. Teresa is more tranquil and Maria is more forceful and tough, she said.

"It may be a little strange at first, but it really is what I wanted," Sanatis said through an interpreter in an interview a week before the surgery. "I'm so happy to be able to see them be the individuals they were born to be."

Complicating matters was the fact that about nearly 88 percent of the liver's blood flow was routed to Teresa, leaving Maria smaller and thinner and Teresa taller and chubbier because Teresa received a much higher portion of the nutrients they took in, Lanning said.

Lanning said he had "extensive conversations" about the Tapia case with Dr. Gary Hartman, the pediatric surgeon who led a team at Stanford University that separated twin girls joined at the chest and abdomen last week.

Sanatis said that after the separation, her daughters will be glad to be able to get away from each other during arguments.

"They fight like siblings who aren't conjoined fight," she said. "But imagine if you have nowhere to go."

The girls are expected to remain in the hospital for about two weeks and stay in Richmond at least another month so they can undergo physical and occupational therapy, along with follow-up visits with doctors. They could return home by the end of the year to reunite with the twins' father, a construction worker, and three other siblings.

About a half-dozen separation surgeries are done in the U.S. annually, Lanning said, and maybe double that number worldwide.

Worldwide, conjoined twins account for between 1 in 50,000 and 1 in 100,000 live births. The condition is three times more likely to occur among females than males. A third of conjoined twins are attached at the lower chest, as in the case of the Tapia twins.