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Conjoined twins visit LIJ for constipation surgery

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Maria Carmen Andrade-Solis, who her family calls Carmen, and her sister Maria Guadalupe, who is known as Lupe, were born in Veracruz, Mexico joined together from the abdomen down. They each have their own heart, lungs and set of arms, but share a stomach, liver, spleen, small bowel, colon and a pair of legs.

Dr. Alberto Pena, the surgeon who performed the operation on Carmen and Lupe, told a news conference Friday that he had seen only a handful of such patients during his 30 years on the job. Conjoined twins occur in one out of every 75,000 to 100,000 births, according to Schneider staff.

"This is a remarkably rare pair of conjoined twins," said Dr. Philip Lanzkowsky, chief of staff at Schneider.

The twins arrived in the United States from Mexico with their older sister, mother and father a year and a half ago to begin preparations for the operation, thanks to Healing the Children, a nationwide non-profit that brings kids from other countries to the United States for medical care.

The twins suffered from constipation since their birth, and to alleviate the problem Dr. Pena moved their rectum, which was too close to their vagina, by using a procedure he developed in the 1980s and for which he has become renowned. He also removed a part of their colon during the operation, which lasted seven hours and involved two surgical teams, one for each twin.

Dr. Pena described the successful surgery as a quality-of-life issue, and said the girls should be released from the hospital later this week. While the twins' mother, Graciela Solis, had hoped when they were born that they could be separated, Dr. Pena said that since they shared so many organs, they could not be split apart without one or both dying.

"At this point it's beyond our capacity to even consider separation," he said. While there have been some successful attempts at splitting conjoined twins, other operations have seen one or both of the twins die. With such high risks, and the chance that one twin could be sacrificed to save the other, separation surgeries can pose tough tests for medical ethics.

"It's a question of very careful clinical judgment," said Lanzkowsky.

Twins become conjoined in the womb when the embryo starts to separate two weeks after conception but fails to divide fully. Such twins can be joined in the head, chest or back, among other types, and while 60 percent are stillborn, others have lived to the age of 63.

Lanzkowsky and Pena said Lupe and Carmen are intelligent and personable. Solis said Carmen likes to talk, but Lupe is shy. Like many children, they like Snow White and Mickey Mouse and fight with each other.

When she learned that she was pregnant with conjoined twins, Solis decided to have them despite the health risks she would face during delivery. She said through an interpreter working as a research associate at the hospital, George Rodriguez, that she was initially depressed after she gave birth. But Solis, a devout Catholic, has since told her girls that God sent them to her this way and that he must have a plan.

"This mother is very unique," Rodriguez said, noting that Solis was not embarrassed or ashamed to take her twins out in public.

But doctors said the twins still faced the challenge of adjusting socially and learning to walk. Each twin's brain controls the leg on that side of their lower torso, and so they must work together, with Rodriguez likening it to a potato sack race.

"They could have a life that will be productive but conjoined," Lanzkowsky said.

The family currently lives in New Milford, Conn., which has a local chapter of Healing the Children, the foundation which brought them to Schneider for the free surgery. They hope to stay in the United States both for better economic opportunities and so the twins can have better medical care.       

To those that have helped her twins, Solis said, "Gracias."

Reach reporter Michael Morton by e-mail at news@timesledger.com or by calling 718-229-0300, Ext. 154.

Posted 7:02 pm, October 10, 2011
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