VCU news

By Malorie Burkett and Shira Cantor

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News Directors: Broadcast access to VCU experts can be arranged through the university’s VideoLink ReadyCam studio. ReadyCam transmits video and audio via fiber optics through a system that is routed to your newsroom. To schedule a live or taped interview, contact the VCU Office of Communications and Public Relations, 804-828-1231. In addition, footage of separation surgery is available upon request.

Children’s Hospital of Richmond at Virginia Commonwealth University today discharged now 20-month-old formerly conjoined twins Maria and Teresa Tapia of the Dominican Republic.

The twins were surgically separated just over three weeks ago during a complex, 20-hour procedure led by David Lanning, M.D., Ph.D., associate professor in the VCU Department of Surgery and surgeon-in-chief, Children’s Hospital of Richmond at VCU. Lanning collaborated with a team that was made up of about 45 physicians and pediatric subspecialists who volunteered their time.

“The girls’ recovery since the surgery has been excellent,” said Lanning. “We are really pleased with their progress and are looking forward to getting them out of the hospital and into the Hospital Hospitality House. Overall, I don’t think we could have asked for a better outcome.”

Previously classified as omphalopagus, the twins were joined at the lower chest and abdomen and shared a liver, part of their biliary system, pancreas glands and the first part of the small intestine or duodenums.

According to Lanning, because of the nature of the twins’ connection with their duodenums, the smaller twin, Maria, was never able to receive the nutritional benefits she needed and was nearly 20 percent smaller in size than Teresa. Another one of the major challenges due to the shared liver was the lack of blood return to the smaller twin.

Three weeks after the surgery, Lanning says that the girls’ organs, including their livers and biliary systems are functioning normally, though Maria’s colon will still need some normal monitoring. The twins also have been taking part in regular physical and occupational therapy sessions to aid them with sitting up on their own and eventually with walking individually.

“Other than relearning how to walk, which shouldn't be too difficult, Maria and Teresa will just need continued strengthening of their abdominal wall muscles,” said Lanning. “They appear to have adjusted to being separated very well and while they enjoy spending time together, they don't appear to need to be right next to each other or in the same crib.”

Maria, Teresa and their mother first came to Children’s Hospital of Richmond at VCU for the twins’ initial evaluation in December 2010 through the World Pediatric Project (WPP) – an organization whose main mission is to link worldwide pediatric surgical, diagnostic and preventative resources to critically ill children in developing countries.

After the twins returned to the Dominican Republic, Lanning and his colleagues in the months following began to carefully map out a detailed treatment plan and conducted comprehensive research on the twins’ anatomies to prepare for the separation procedure. This included studying MRI scans and imaging to determine the placement of the twins’ shared organs.

The twins returned to Richmond with their mother Lisandra Sanatis and aunt Maria Reynaldo Valdez at the end of August and remained close to the hospital for additional exams, imaging and a procedure in which the surgeons placed tissue expanders in the twins. The balloon-like expanders enabled the growth of excess skin to be used for reconstruction following surgery.

In the months leading up to the procedure, the surgical team carefully planned the step-by-step detailed operative timetable, which included specifications on times for the various aspects of the surgery.

The 20-hour separation procedure commenced Nov. 7 around 6 a.m. and was the first surgery of its kind at Children’s Hospital of Richmond at VCU.

Critical members of the separation surgical team included Jennifer Rhodes, M.D., assistant professor in the VCU Department of Surgery’s Division of Plastic and Reconstructive Surgery and director of Children’s Hospital of Richmond at VCU’s Center for Craniofacial Care; Robert Fisher, M.D., professor of surgery and director of the liver transplant program; and Claudio Oiticica, M.D., associate professor of surgery.

Lanning also worked very closely with the Division of Pediatric Anesthesiology, who played an integral role in the planning, simulation and preparation of the case and all of the procedures leading up to and including the separation surgery.

The anesthesiology team closely monitored the girls and ensured that they were safe throughout the long surgery. Key anesthesia team members included Jay Shapiro, M.D., professor; Jeanette Kierce, M.D., Arkadiy Dubovoy, M.D., James Dore, M.D., assistant professors; and Iolanda Russo-Menna, M.D., assistant professor, pediatric anesthesiology.

Following the separation surgery, Teresa was taken to another operating room and teams completed the final steps of the surgical process on each child. The girls were then transported to individual rooms in the pediatric intensive care unit for recovery after the procedure, where separate medical teams were dedicated to the care of each child.  On Thanksgiving day, Maria and Teresa were moved to the pediatric Acute Care Unit, where the two girls were able to share a single room in separate beds. 

“I am extremely proud of our team members at Children’s Hospital of Richmond at VCU and World Pediatric Project and also appreciate the support from the Hospital Hospitality House,” said Lanning. “Everyone who has contributed to the care of these girls has really delivered a home run and made it possible for these girls to live healthy and functional lives. They now have the ability to be close to each other yet have the option to do things independently.”

Maria and Teresa along with their mother and aunt will remain nearby at the Hospital Hospitality House over the coming weeks as the girls continue to recover and take part in occupational and physical therapy and outpatient follow-up appointments. Once their initial round of therapy and post-surgical follow-up care is complete, the family will return to the Dominican Republic.

“My experience at Children's Hospital of Richmond at VCU was a beautiful experience,  particularly the medical team, the nurses who have been so gracious and made me feel like family,” said Sanatis. “The nurses have all been nurturing and caring not only with my girls but with my sister and me.

I am very much looking forward to going back home and bringing my girls back to see their brothers and spending time with my children.”