Conjoined Twins Who Share a Liver, Chest, Abdomen Separated After Ten-Hour Surgery

A team of surgical doctors successfully separated ten-month-old conjoined twins Addison (Addy) and Lilianna (Lily)  after a ten-hour operation at the Children's Hospital of Philadelphia on October 12, 2021.

Addy and Lily are thoraco-omphalopagus twins, a condition where twins share a liver, diaphragm, chest, and abdominal wall. 

A special journey

Conjoined twins are rare as it happens once in around 50,000 to 200,000 births. It is risky as well as researchers say that 60% of conjoined twin pregnancies end in stillbirth. Separating the twins is also difficult as only 60% of separated conjoined twins survive after the surgery.

Parents Maggie and Dom Altobelli assumed they had one baby. When they had a prenatal for their 20-week ultrasound appointment, they were surprised to know they had twins and were also attached to the abdomen.

Maggie, the mom, told NBC, "I was trying to find out the gender of one baby I thought we were having, and then it turned out to be a little more complicated." 

The couple was referred to Children's Hospital of Philadelphia (CHOP) since the hospital is one of the few hospitals in the US with experience in handling conjoined twins.

Since then, the couple was subjected to extensive prenatal testing to check the possibility of separating the twins after birth.

The doctors discovered that the twins had different, healthy hearts despite sharing a chest, abdominal wall, diaphragm, and liver.

Medical experts at the Children's Hospital determined that the twins were good candidates for separation. They have separate hearts and a liver big enough for them if divided.

Addy and Lily were born on November 118, 2020, and had to spend four months in the Newborn/Infant Intensive Care Unit (NICU) and six months in Pediatric Intensive Care Unit (PICU).

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The complex ten-hour-surgery

The surgery team involved more than two dozen specialists, anesthesiologists,general surgeons, cardiothoracic surgeons,  radiologists, and plastic surgeons.

To prepare for the surgery, the surgical team met every week to study the ultrasound images to study the blood flow and vasculature. The radiologists designed 3D models put together like Lego pieces so that the surgical team would understand the twins' anatomy and practice for the surgery.

 Finally, almost a year since the twins were born, the twins underwent a 10-hour surgery. After the twins were separated, the surgical team was divided into reconstructing the girl's chest and abdominal wall.

When parents Maggie and Dom saw their daughter separated for the first time after the surgery, Maggie said it was terrific. "It was just indescribable," she added.

Home at last

The Altobellis finally flew home to Chicago after spending almost a year in Philadelphia. Before heading home, the twins had to spend two weeks at Lurie Children's Hospital but were discharged in time for Christmas.

The twins still have ventilators and tracheostomy tubes attached to them to aid in their breathing as they will need more time to develop musculature and adjust to their breathing.

According to Dom, although the conjoined twins have separated, they still share a special bond like reaching for each other's face, hands, and breathing tubes when they are close.

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