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Conjoined twins undergo first phase of operation
By Kelly Rayburn
Daily bruin senior staff
krayburn@media.ucla.edu
The Associated Press Conjoined twins Maria de Jesus Quiej-Alvarez, left, and Maria Teresa play in their hospital bed at UCLA Medical Center in Los Angeles, Saturday, June 22, 2002.
Eleven-month old Guatemalan twins who are joined at the head underwent a skin expansion procedure last week at the UCLA medical center. It was just the first part of a rare separation operation. Maria de Jesus and Maria Teresa Quiej-Alvarez responded well to the anesthesia and the surgery, doctors said, but a small tear in their skin, incurred during the operation, may delay their next surgery. Last week’s skin expansion procedure was “almost a dress rehearsal for the twins’ longer surgeries next month,” said Dr. Henry Kawamoto Jr., a UCLA plastic and reconstructive surgeon, on June 24, after he conducted the 75-minute surgery. The most difficult part of the $1.5 million procedure, which UCLA is doing for free, will be separating two major veins that connect the front of each girl’s head to the back of the other’s. During last week’s preliminary operation, doctors prepared the girls for their separation by threading two eight-inch long silicone balloons under each girl’s skin, near the groove where their heads are joined, a statement from the Medical Center said.
The Associated Press Albaletecia Alvarez, center, talks to her daughters, as they drink their bottles in their hospital bed at UCLA Medical ceneter.
The end of the balloons runs in a hose with a self-sealing valve, into which doctors will inject saline solution twice a day. As the balloons inflate the twins’ tissue will expand, preparing them for separation. Skin expansion will stretch the skin of the twins’ scalps enough to cover the backs of their heads after their separation surgery, doctors hope. Surgeons encountered a minor problem when inserting one of the balloons, as the twins’ scalp skin tore in a thin spot. The balloon near the wound, which was stitched up, will not be inflated until that area fully heals, doctors said. This may delay the next surgery, scheduled originally for some time in July. As of last week, doctors were still not sure when the twins would undergo the next procedure. Despite the small problem, overall doctors were satisfied with the surgery. “We’re very pleased,” said Dr. Barbara Van De Wiele, chief anesthesiologist on the case.
Rare twins, risky procedure Maria de Jesus and Maria Teresa have spent almost their entire lives in hospitals. In their bed, they struggle unsuccessfully to help one another stand up. The hold hands often, but they cannot meet eyes. Joined at the head, they are the rarest of twins. Craniopagus twin – those joined at the head – make up only 2 percent of conjoined twins, according to the Med Center statement. And their separation is one of the most dangerous of all operations. Doctors have performed cranial separations only five times in the past 10 years, and not all twins have survived. This is the first time the procedure has happened at UCLA. If one of the balloons breaks or if the veins running through their heads cannot be separated, the girls could suffer brain damage. But UCLA neurosurgeon Jorge Lazareff, who lobbied the hospital to accept the case, has confidence in the girls to pull through. “They are really tough girls,” he said at a press conference on June 24. “I am absolutely thrilled and convinced they will do great.” With reports from The Associated Press
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