Conjoined twins undergoing separation surgery

NEW YORK: After tearful kisses from their mother and grandmother, two-year-old conjoined twins from the Philippines underwent surgery yesterday to separate them. Surgery on Carl and Clarence Aguirre, the feisty, dark-haired brothers who are joined at the top of their heads, began at 10 am (1400 GMT), said Steve Osborne, a spokesman for the Children’s Hospital at Montefiore Medical Centre in the Bronx. The twins could be detached by Wednesday night, Osborne announced hours later, quoting surgeon Dr James Goodrich as saying, “We’re committed to go for separation.” The hospital scheduled a news conference today to release details of the surgery. The surgeons had said they would delay a decision on separation until they could see how the boys endured their fourth major operation since October.

Their mother, Arlene Aguirre, and her mother, Evelyn Aguirre, accompanied by several Filipino nurses from Montefiore’s staff, had left the boys at the door of the operating suite with kisses and tears. The mother had brought them to New York from the Philippines last September. Osborne said the room was “quiet and intense” as the first incision was made, with about 16 doctors, nurses and technicians on hand. The plan called for making a “window” in the skull, cutting the last major vein still being shared by the brothers, then teasing apart their separate brains in the one small area that had not already been separated. That operation had not yet been completed when Goodrich, a neurosurgeon, made his announcement and Dr David Staffenberg, the boys’ plastic surgeon, “gave a thumbs-up sign,” Osborne said.

In a hospital statement, Staffenberg said the boys were “both stable and doing nicely.” “While we are clearly excited about our progress, the risks are very real to us, and every move we make is critical to Carl and Clarence, so were being very cautious,” he said. Hospital spokeswoman Pamela Adkins said the two doctors had informed the boys’ mother that they decided to go ahead with separation. Dr Robert Marion, the boys’ pediatrician, said the boys’ vital signs and blood work had shown no problems during surgery. The surgeons said last week they were most worried about excessive bleeding and swelling of the brains. After deciding to go ahead, the doctors were expected to complete the separation by removing much of the remaining skullbone.

They would have to reconstruct the membrane that covers the brains, and cover the heads with skin. Doctors have chosen an approach employed only a few times before on conjoined twins, replacing the typical marathon two-day separation surgery with four shorter procedures over ten months. Most of the blood vessels around the brain had been cut and divided already, and the boys’ brains have been partially separated. The doctors have donated their services, as have Montefiore and Blythedale Children’s Hospital in Valhalla, where the twins have been living between surgeries and receiving physical therapy.