A Successful Separation

Jan. 3, 2007— -- Following a 99-day hospital stay and a surgery that lasted more than six hours, a pair of formerly conjoined twins is recovering from the operation that separated them.

Before the surgery, 5-month-old conjoined twins Abygail and Madysen Fitterer, of Bismarck, N.D., were joined at the chest and shared their front chest wall.

The insides of their bodies were so intertwined that their livers had nearly fused into a single organ. And the surgeons said Madysen's heart was halfway inside her sister's chest.

Despite these complexities, a surgical team at the Mayo Clinic in Rochester, Minn., led by pediatric surgeon Dr. Christopher Moir succeeded in leaving each of the girls with the organs necessary for their survival.

Moir also led the teams that separated conjoined twin girls from Fargo, N.D., in May and twin boys from Mankato in November.

At a press conference held after the surgery, Moir said the surgery began at 9:50 a.m. CST.

At 12:27 p.m., Abygail and Madysen were placed on separate operating tables, successfully separated. The teams then began reconstructing the chest walls of both girls. Madysen's reconstruction was finished first at 3:36 p.m., while Abygail's was completed at 4:05 p.m.

The parents of the twins, Stacy and Suzy Fitterer, said at the press conference that they were relieved at the results of the procedure.

"I don't think we've ever felt so strong and so weak," Suzy Fitterer said. "I don't know how you thank people for giving not one but two of your children a chance at a normal life."

Surgery Was a Complex Undertaking, Surgeons Said

"These are phenomenal surgeries," Moir said. "Every surgery is different, every surgery has its own complexities, and Abby and Maddie certainly gave us some complexities to deal with.

"I think how we rate it, it's off the scale, you just can't rate these surgeries from the complexity and as well as from the teamwork."

Moir and Dr. Joseph Dearani, the cardiovascular surgeon involved in the operation, said the most difficult part of the operation had to do with their hearts.

"The hardest part of the operation was trying to reposition the heart in each of their respective chests in a way in which you can get as much of the chest wall covering the heart as possible," Dearani said.

This added complexity is a hallmark of nearly every operation designed to separate conjoined twins. Since the organs of many conjoined twins are connected -- or even completely shared -- surgeons must be particularly careful to leave each twin with the tissues he or she needs to survive.

"As you can imagine, it takes the normal complexity of surgery to an increased level," said Dr. David Staffenberg, chief of plastic surgery at the Children's Hospital at Montefiore in the Bronx, N.Y.

Though he was not involved in the Fitterer case, Staffenberg has been part of surgical teams to separate two sets of conjoined twins in the past.

"There are two lives in the balance, so built in we have two times the precautions," he said. "The variations in anatomy and other variables that you need to keep a watch on are just overwhelming."

Additional Surgery May Be Needed

Though the safe separation was a successful conclusion for the surgical teams at Mayo, the twins will likely face a number of obstacles on their way to recovery and rehabilitation.

And there may be more surgery in the future. This is because the surgeries left the chest cavities of both girls partially open.

But Dr. Claude Deschamps, a thoracic surgeon who took part in separating the girls, said these procedures may be years in the future.

"I think it's just going to take time before we know, but I wouldn't anticipate additional surgery in the foreseeable future," Deschamps said. "It would be down the road quite a bit."

The girls will be closely monitored throughout their recovery, and the surgeons did not give a precise date as to when they would be allowed to go home. But Moir said the fact that the twins made it through the operation as well as they did bodes well for their recovery.

"They are beautiful little girls," Moir said. "They have a lot of tubes and lines right now, they are swollen from the surgery, but underneath you can see the Abby and Maddie we have grown to love."