Separate but never apart

Published On 02/15/2017

Le Bonheur separates second set of conjoined twins

A team of Le Bonheur pediatric surgeons and specialists separated 12-month-old ischiopagus conjoined twin girls in November. The 18-hour procedure involved a team of more than 20 surgeons and physicians from five subspecialties.

MRI Conjoined TwinsThe girls, Miracle and Testimony Ayeni, are now undergoing rehabilitation at Le Bonheur Children’s after a successful separation surgery.

The Ayeni twins were born in Enugu State, Nigeria, on Nov. 16, 2015, via a caesarian. The girls, who were diagnosed as conjoined in utero, shared a large intestine, two bladders and a pelvis. In early 2016, the Nigerian-based Linking Hands Foundation sought Le Bonheur’s help on behalf of the Ayenis.

The surgery was Le Bonheur’s second separation of conjoined twins in the past five years. A team of specialists from the areas of anesthesia, child life, critical care, pediatric surgery, orthopedics, nursing, plastic surgery, radiology, rehabilitation therapy, social work, spiritual care and urology met weekly for four months prior to the surgery to plan the separation.

More than 20 physicians and surgeons were involved in separation – and another 100 nurses and other clinicians involved in their care.

“I know they will walk, I know they will do everything,” said Mary Ayeni, the twins’ mother. “God used the hospital to save the lives of Miracle and Testimony.”

Miracle and Testimony Ayeni: At Le Bonheur

June 27, 2016: Ayeni family arrives at Le Bonheur, connected through the Nigerian-based Linking Hands Foundation.  Family begins living at Le Bonheur’s FedExFamilyHouse.

TwinsbeforesurgeryWEB

July-October 2016: Le Bonheur physicians perform tests and scans to learn more about where Miracle and Testimony are conjoined and which organs the girls share. The twins begin physical and occupational therapy to meet developmental goals while their surgical team begins to meet weekly to discuss separation plan.

Oct. 3, 2016: Plastic surgeons insert four tissue expanders that will help grow excess skin and cover their wounds after separation.

Nov. 7-8, 2016: Miracle and Testimony are separated in a 18-hour procedure that involves more than 20 physicians. They leave the OR wearing external fixators designed to stabilize their pelvis bones. 

surgeryWeb

Nov. 16: Miracle and Testimony celebrate their 1st birthday at Le Bonheur.

Dec. 20: Orthopaedic surgeons remove the external fixators, as their pelvis bones have stabilized. Twins begin more intensive physical therapy.

Miracle and Testimony Ayeni: Separation Surgery

team collaborationWeb

Nov. 7

7:05 a.m. Anesthesia induction begins and intravenous lines are inserted.

8:45 a.m. Orthopedics team marks posterior tibial arteries; general surgery team marks abdominal incisions.

9:06 a.m. Twins are rolled onto their stomachs; urology team places foley catheters; general surgery marks spots to create anus and rectum

9:43 a.m. Twins are rolled onto their backs; team applies sterile drapes

10 a.m. Pediatric surgery divides colon and separates the conjoined bowel

11:15 a.m. Plastic surgery and urology teams make incisions to access the ureters

12:10 p.m. Urology team mobilizes and divides the ureters.

2 p.m. Orthopedics teams divides the two shared pubic bones

2-3 p.m. Urology and pediatric surgery teams complete soft tissue dissection

3:16 p.m. Girls are separated and Testimony is moved to Operating Room 6.

after separationWEB

Miracle

3:50 p.m. Plastic surgery team removes Miracle’s right tissue expander and makes incisions for osteotomies

5 p.m. Orthopedics team completes reshaping of Miracle’s pelvic bone

5:55 p.m. Pediatric surgery team completes creation of anus and rectum.

7 p.m. Urology team completes ureter to bladder connection.

8:30 p.m. Orthopedics team begins pin placement and external fixator to hold pelvis in place

9:15 p.m. Pediatric surgery team closes the perineum

11:40 p.m. Plastic surgery team completes removal of tissue expanders, placement of patch between the pubic bones in the midline and abdominal wall reconstruction

12:06 a.m. (Nov. 8) Orthopedics team completes readjustment of the external fixator. Surgery is complete. Miracle is transported to the Pediatric Intensive Care Unit.

Testimony

3:15 p.m. Team begins incisions to reshape Testimony's pelvis

5:56 p.m. Orthopedics team completes reshaping of pelvic bone

7:30 p.m. Urology team completes the new connection between Testimony’s ureter and her other ureter.

8:15 p.m. Pediatric surgery team completes colon to small intestine connection

9:30 p.m. Orthopedics team completes placement of pins and an external fixator to hold pelvis in position.

12:25 a.m. (Nov. 8) Plastic surgery team closes the perineum and abdominal wall after removing tissue expanders.

12:55 a.m (Nov. 8) Orthopedics finishes readjusting the external fixator and surgery is complete. Testimony is moved to Pediatric Intensive Care Unit.

Ayeni family