Oneal THE CHILDREN’S HOSPITAL OF PHILADELPHIA Vol. X No. 7 Special Edition November, 1974 A NEW LIFE FOR CLARA AND ALTA pe ese yw sia antral re WES 9 te atiols : ‘Being Separated in Phi ; Siamese Twins parat mye ten eegteamge gts tts, coe Een mt: i irl the 1 Continued fram First Page today’s complex surgery, in- ARETE RA Me SS a according 19 plan, 2a ee the ext well have gained weigh! SPN “he abdomen an If everything works out, each — shat tney have only one ree op ro heart prablem. Pelvic bones of the twins girl will bea whole person... single vital organ must bE tran But unless. they're S€P& oye been fused together given to ont twin or the Dr rated, each girl's legs will since birth, dnd when separ en.att. « se ie a en shrivel from disuse; they Cam ated each girl will have an | teams Per cop sant the vestigial develop into normal women incomplete pelvis, shaped like nect urett 7 b wo Oe E0ee rector have only if each has an opportun!~ a “C rather than a complete kidneys ¥ 1g Tecum have ty to Tear to walk, run and = Ting. own blad¢ f Fe % play at the usual stage of If the girls were newborn, it ; ; would be possible to bend “Mahood for those activities. heir pliable pelvic bones into e ring again, said Dr. Koop, Ms we) ned an “ ne oars TaN IM 1945, ot Pata ted 1 a want bic ae ye 23 Doctors and Nurses In. Fa ed Surgery on Babies Born 1 yee Joined atthe Torso. j* PHILADELPHIA, Sept. 18 (UPI—A relatively rare opera- lion to separate Siamese twins; completed in about eight] v=o team of 23) Steen Protae- mese pasty WR ie twins Everty 3g Twins Separated Here Hospita UT geons erate ty Separate Sig tion came, © twins’ a0... wet “She didn’ Warn i Sys. + Schnaufer wus. have troukins | Mem wily DIGESTIVE SYSTEM vA URINARY SYSTEM ¢ KIONEYS KIDNEYS Be 4 7 of colen oe Sorting x Individual small intestines Jead into Sectio * BLADDER Ln out the twins: Diag sl 7 . Diagram shows how surgeons corrected babies digestive and urinary abnormalitiee Newsweek, September 30, 1974 10'2-Hour Operation Combined Several Surgical Techniques Commonly Used At Children's Hospital Procedures performed on the twins that are performed several times each year at Children’s Hospital Average Number Performed at Children’s in a Year Imperforate Anus 8.5 Procedure The twins shared a rectum which was given to Clara at separation. However, Dr. Koop was able to build a new rectum for Alta using another muscle as a rectal sling. Omphalocele 13.5 Since the twins are joined facing each other both had a large abdominal wound after separation. By breaking the pelvic bone, pulling the hips around and suturing the pelvis together, the wound was closed in Alta. Clara had enough skin to close the wound so that no artificial skin was needed to bridge the gap in the abdominal wall. 3 : ue q i The Siamese twins were brought to the operating room at 5:45 a.m, ‘tans Ureteroureterostomy 2 and were positioned on foam rubber wedge-shaped cushions which were In the twins, the ureters were crossed and drained into pulled back as the youngsters were separated. Pre-operative prepara- the other ureter. They had to be resected. This technique is tions took four hours. Clara and Alta were ready for surgery at 10:10 different from the usual implantation of ureters into the a.m. Dr. Josephine Templeton (above), anesthesiologist, comforts Alta. bladder and was chosen in order to avoid entering the during pre-operative preparations. bladder and making another opening. Two full surgical teams worked simultaneously. Twenty-three members of the O.R. staff were needed for the separation procedure. Dr. John J. Downes, Jr., headed the anesthesiology team. Dr. John W. Duckett, Jr., headed the urology team. Orthopedic surgery was performed by Dr. Stanley Chung, Children’s chief of orthopedics. Dr. Koop was assisted by Dr. Louise Schnaufer, associate surgeon, and chief surgical residents Dr. Edwin Hatch and Dr. John M. Templeton, Jr. Though the separation of the Rodriguez twins received world-wide ac- claim, Dr. C. Everett Koop, surgeon-in- chief at Children’s, notes that each proce- dure performed on Clara and Alta is performed many times a year at Chil- dren's Hospital. The separation of the twins was unique because it involved all of the procedures at once. “For example,” Dr. Koop explained, “we build several rectums a year at Children’s because some infants are born Actual separation took place at 12:37 p.m. without a rectum. Many are born without abdominal walls. “None of the techniques used on the twins was new to us. We just had to decide the order in which we would make the repairs.” Dr. Koop continued, “This is where our planning sessions were crucial. | estimate that 100 man-hours went into the planning of this operation. “We had to consider everything that could go wrong and decide how we would handle each crisis. The anesthesiology team had a tremen- dous responsibility. They were respon- sible for the life sustaining devices during surgery. Dr. John J. Downes, Jr., headed the Anesthesiology team. “| can honestly say that everything went right during the operation. The skull sessions paid off. Surgery was completed successfully at 5:10 p.m.,” Dr. Koop concluded. Dr. Koop spoke to the media after the operation to report that the twins were doing “very well,” Clara, the larger twin, was taken off the respirator 48 hours after surgery, 24 hours before her smaller sister. When Clara woke up she was placed in her sister’s crib. On seeing Alta she became very quiet, then reached out to touch Alta’s hand. The youngsters remained in the same bed while at Children’s Hospital. At first nurses observed that the twins constantly sought each other out. They clung to each other’s nightgown strings while sleeping. Before separation Clara had been the dominant twin. Because she was larger she always won the squabbles. But after surgery Alta acquired a more aggressive personality of her own. NURSES HELP TWINS ADJUST TO SEPARATION (@H TIMES Published for the staff and employees of The Children’s Hospital of Philadelphia, One Children’s Center, 34th & Civic Center Bivd., Phila., Pa. 19104. Richard D. Wood Chairman, Board of Managers Charles E. Ingersoll! President Warren C. Falberg Executive Vice President and Director Shirley Bonnem Director of Public Relations Susan Soiferman Assistant Director of Public Relations Mary Thomson Editor Both children were put on soft diets seven days after surgery. On the twelfth day they Materials used may be reprinted without began to eat solid foods. Nurses reported they were eating well and gaining weight. given to sounse appropriate credit is | 1. wasn’t fong before the girls were smiling again. They learned to wave and Clara called “Bye-Bye” to everyone leaving the Intensive Care Unit.