Conjoined twins undergo first phase of operation

By Kelly Rayburn
Daily bruin senior staff
[email protected]

  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