LOS ANGELES, June 13, 2006 (PRIMEZONE) -- On Wednesday, June 14, 2006, a team of nearly 80 people at Childrens Hospital Los Angeles -- general, orthopaedic and plastic surgeons, anesthesiologists and nurses, as well as other caregivers and specialists -- will separate conjoined twin girls, Regina and Renata Salinas Fierros, who are joined at the lower chest through the pelvis, facing one another.
Regina and Renata, who were born at LAC+USC Medical Center on August 2, 2005, were transferred to the Center for Newborn and Infant Critical Care at Childrens Hospital Los Angeles the following day. They have been seen regularly at the hospital since their birth, undergoing various diagnostic procedures, a reversible colostomy and the insertion of "tissue expanders" to gain additional skin and soft tissue to close the open wounds after the separation surgery.
Regina and Renata are a type of conjoined twins known as "Ischiopagus Tetrapus." ("Ischio is a Greek word for "hip," "pagus" for "fixed" or "united," and "tetrapus" means "fetus with four feet.") Ischiopagus twins are among the rarest and most complex to separate because they involve many organ systems -- liver, intestine, urinary, reproductive, vascular and musculo-skeletal systems.
Pediatric Surgeon James E. Stein, M.D., FACS, FAAP, will head the team that will separate and care for Regina and Renata in a series of operations that will begin on Wednesday (June 14) at 6 a.m., and are expected to conclude 24 hours, or more, later. He will be joined by Childrens Hospital Drs. Cathy Shin and Donald B. Shaul.
Dr. Stein is an attending pediatric surgeon at Childrens Hospital Los Angeles and an assistant professor of surgery at the Keck School of Medicine of the University of Southern California. He also led the team that successfully separated conjoined twins at Childrens Hospital Los Angeles on Sept. 11, 2003, in a rare, highly complex and historic procedure. Those twin girls, who were known publicly as 'Baby A' and 'Baby B' to protect their identities as wards of the court, were a type of conjoined twins known as "Ischiopagus Tripus." ("Ischio" is a Greek word for "hip," "Pagus" for "fixed" or "united," and "Tripus" for "three legs.") Those girls, along with their triplet sister, have been adopted by a wonderful family and continue to thrive together in another state.
While one of the rarest types of conjoined twins, Ischiopagus twins also are among the most complex to separate, according to Dr. Stein. "Since they involve so many organ systems -- liver, intestine, urinary, reproductive, vascular and musculo-skeletal systems -- we are utilizing nearly every area of expertise offered at Childrens Hospital Los Angeles."
The separation will involve, perhaps, a dozen surgical procedures, according to Dr. Stein. "The first phase includes dividing the breastbone, liver, intestine, urinary bladders, genital organs and the bony pelvis. During the second phase, the chests, intestines, vaginas, ureters, pelvises and body walls all will be reconstructed."
-- Dominic Femino, M.D., will lead the orthopaedic team, which will
include Drs. David Skaggs, Jennifer Weiss and Paul Choi.
Dr. Femino is an attending pediatric orthopaedic surgeon at
Childrens Hospital Los Angeles and an assistant professor of
clinical orthopaedic surgery the Keck School of Medicine. He was
on the 80-member team that separated the conjoined twins on
Sept. 11, 2003.
-- John Gross, M.D., FACS, will lead the plastic surgery team, which
will include Drs. Mark Urata, Jeff Lagrasso and Max Lehfeldt.
Dr. Gross is an attending pediatric reconstructive and plastic
surgeon at Childrens Hospital Los Angeles and an assistant
professor of surgery at the Keck School of Medicine. He led
the plastic surgery team that separated the conjoined twins on
Sept. 11, 2003.
-- William McIlvaine, M.D., C.M., FRCPC, FAAP, will lead the
anesthesia team, which will include Drs. Janice ("Jae")
Townsend, Anthony Romo and Patrick Ross. Dr. McIlvaine is
associate chairman of Anesthesiology Critical Care Medicine at
Childrens Hospital Los Angeles and an associate professor of
clinical anesthesiology at the Keck School of Medicine. He led
the anesthesia team that separated the conjoined twins on
Sept. 11, 2003.
Following surgery, Regina and Renata will be cared for in the 20-bed Pediatric Intensive Care Unit (PICU) at the hospital. The care of the children and their family will be headed by Niurka Rivero, M.D., and another large team of nurses, respiratory therapists and physicians in the "...crucial..." 24-48 hours following surgery, according to Randall C. Wetzel, MB, BC, FCCM, FAAP, chief of the Department of Anesthesiology Critical Care Medicine at the hospital. Children in the PICU are treated by pediatric intensivists, some of whom are double and triple board certified with expertise in cardiology, pulmonology and anesthesiology in addition to training in general pediatrics and critical care medicine.
Regina and Renata are considered the ideal age to undergo the surgery, says Dr. Stein. "Their tissues and bones at this age tend to be both firm and pliable enough -- and also of a reasonable size -- to manipulate them easily," according to Dr. Stein. "If the surgery were not performed, the twins' anatomy would begin to limit their quality of life over time -- taking away their individuality, their ability to walk and to develop normally. There are psycho-social issues of separation and identity involved in separating conjoined twins more than one-year-old."
Dr. Stein says that there is another compelling reason for scheduling the separation now: For several months, Regina has not been gaining weight well, despite having a hearty appetite, and he believes that more of Renata's blood vessels may be supplying the girls' intestines, thereby robbing Regina of essential nutrients.
Founded in 1901, Childrens Hospital Los Angeles has been treating the most seriously ill and injured children in Los Angeles for more than a century, and it is acknowledged throughout the United States and around the world for its leadership in pediatric and adolescent health. Childrens Hospital is one of America's premier teaching hospitals, affiliated with the Keck School of Medicine of the University of Southern California for more than 74 years. It is a national leader in pediatric research.
Since 1990, U.S. News & World Report and its panel of board-certified pediatricians have named Childrens Hospital Los Angeles one of the top pediatric facilities in the nation. Child magazine also ranked Childrens Hospital Los Angeles among the Top Ten children's hospitals in America in its February 2005 issue.
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