Searation of conjoined twins, the world’s rarest surgery

On October 13, 2021, the conjoined twins Addison (Addy) and Lilianna (Lily) ltobelli were successfully separated at Children’s Hospital of Philadelphia (HOP). The girls were born with thoraco-omphalopagus twins, meaning they shared a liver, diaphragm, chest wall, and abdominal wall.

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Addy and Lily’s journey began with their prenatal diagnosis at a 20-week scan. Prior to this consultation, Maggie and Dom ltobelli believed they were expecting one child, but an ultrasound revealed that Maggie was carrying two babies that were linked at the abdomen.

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Conjoined twins are uncommon, occurring in around 1 in 50,000 births. The couple was directed to HOP for additional assessment, since it is one of the few hospitals in the nation with expertise separating conjoined twins. Since 1957, more than 28 sets of conjoined twins have been split at HOP, more than at any other hospital in the country.

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The pair visited the Richard D. Wood Jr. Center for Prenatal Diagnosis and Therapy at HOP. Despite sharing a chest and abdominal wall, diaphragm, and liver, the twins were found to have distinct, healthy hearts. Their combined liver was also large enough to be divided, making them great surgical candidates for separation.

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LaLa News

ddy and Lily were delivered on November 18, 2020, at the Garbose Family Special Delivery Unit (SDU), HOP’s inpatient delivery unit, after months of preparing for a high-risk -section birth directed by Julie S. Moldenhauer, MD. Four months were spent in the Newborn/Infant Critical Care Unit, followed by six months in the Pediatric Intensive Care Unit. Dr. David W. Low, a plastic surgeon at HOP, placed skin expanders to prepare the girls’ skin for separation surgery. The skin expanders progressively inflate by injections, like little, collapsing balloons, so that each girl would have sufficient skin to cover her exposed chest wall and belly following separation.

LaLa News
LaLa News

On October 13, 2021, at 2:38 p.m., after months of preparation, Addy and Lily underwent a ten-hour operation and were legally separated. More than a dozen experts, including general surgeons, anesthesiologists, radiologists, a cardiothoracic surgeon, and plastic surgeons, comprised the surgical team led by Holly Hedrick, MD. After separating the twins, the surgical team repaired the chest and abdominal wall of each girl. Cardiothoracic surgeon Stephanie Fuller, MD, ligated the girls’ patent ductus arteriosus and ensured that both girls’ hearts were in the proper place and working properly. Across the stomach and chest walls of the twins, plastic surgeons inserted two layers of mesh – one temporary and one permanent – and then covered it with skin that had been stretched for months.

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After spending more than a year in Philadelphia, the Altobellis returned to Chicago on December 1, 2021, one twin at a time accompanied by one parent. The twins spent two weeks at Lurie Children’s Hospital under the supervision of the medical team that will provide care for them at home. The girls were discharged just in time for Christmas, and when they returned home, their neighbors had decorated their yard. They celebrated the holiday as a family of four at home.

LaLa News
LaLa News

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