It is one of the most complex surgeries ever performed.
In a press conference today, doctors said they successfully separated 11 month-old twin girls Ballenie and Bellanie Camacho after a 22-hour procedure.
After more than three months of preparation, the girls, who were joined at the lower back, are recovering from their operation in the ICU.
Conjoined twins occur in approximately one in 200,000 births, but twins joined at the hip — called pygopagus — are extremely rare.
Doctors had to separate the girls’ gastrointestinal tracts, bladders, reproductive areas and lower portion of the spinal cord, with a 23 percent chance of death.
But the prognosis looks good and, should no complications emerge, the girls will be back home in just a few months.
Twin girls Ballenie (left) and Bellanie Camacho, from the Dominican Republic, were born joined at the hip, known as pygopagus. Surgeons were able to separate them in a complex 22-hour procedure
Ballenie and Bellanie’s conjoined attachment – which occurs in the spine but leaves each twin which separate limbs – is extremely rare. The babies are recovering well in the ICU, doctors say
The girls’ parents, Marino Abel Camacho and Laurilin Celadilla Marte, did not know they were conjoined prior to birth. Conjoined twins occur in about one in 200,000 births.
The six steps surgeons took to separate Ballenie and Bellanie are shown in this X-ray image of pygopagus conjoined twins
At an emotional press conference, the twins’ parents, Marino Abel Camacho and Laurilin Celadilla Marte, thanked Maria Fareri Children’s Hospital, where the girls have been since the summer.
Laurilin read from a statement: ‘We are eternally grateful to Maria Fareri Children’s Hospital. Thank you for accepting the challenge which has changed our lives.
‘Our family does not know how we can pay for what we’ve been given but we ak that God bless every one of you.’
Once a feasibility conversation was had among the various surgeons that they would be able to separate the girls, doctors began to prepare for the complex surgery.
The medical teams performed multiple practice sessions using 3-D models of the little girls’ lower body constructed from CAT scans and MRIs.
Ballenie and Bellanie were connected at the sacrum, a triangular bone at the base of the spine.
They shared gastrointestinal connections and a branch of the hypogastric artery, which is the main supplier of blood to the pelvic region, hips, thighs and reproductive organs.
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The day of the surgery, which started on January 17 and went into the morning hours of January 18, involved numerous medical teams and nurses, including neurosurgeons, orthopedic, urological, gastrointestinal, pediatric, and plastic surgeons.
‘It was an overwhelming sensation that I don’t think any one of us is going to experience again,’ pediatric surgeon Dr Samir Pandya told TODAY.
‘There was pride, gratitude and just elation that we were able to achieve this for them.
‘Ballenie and Bellanie are as strong as they are beautiful and this dynamic duo is doing very well after a very long and complex surgery.’
The prognosis for the twins is good. They are moving out of the ICU on January 30, but will spend several weeks in recovery at Maria Fareri Children’s Hospital.
At an emotional press conference, the twins’ mother Laurilin (middle) read from a statement: ‘We are eternally grateful to Maria Fareri Children’s Hospital. Thank you for accepting the challenge which has changed our lives’
Ballenie and Bellanie (pictured shortly after birth) were connected at the sacrum, a triangular bone at the base of the spine. They shared gastrointestinal connections and a branch of the hypogastric artery, which is the main supplier of blood to the lower extremities
The smaller of the girls, Ballenie (pictured left) was born with a congenital heart condition. Doctors in the Dominican Republic warned her parents that she might die
Laurilin and Marino (pictured with their daughters on the morning of surgery) brought the girls to Maria Fareri Children’s Hospital in Valhalla, New York over the summer. Doctors then began preparing the procedure to separate the girls
Surgeons position one of the girls before the operation. The medical team consisted of neurosurgeons, orthopedic, urological, gastrointestinal, pediatric, and plastic surgeons
The identical twin girls born in Moca, Dominican Republic, in February 2016 were delivered via C-section.
Laurilin knew she was expecting twins, but did not realize the babies were conjoined.
Not long afterwards, the smaller of the twins, Ballenie, was diagnosed with a congenital heart condition. Doctors warned her parents that she might die.
Over the summer, Laurilin and Marino brought the girls to Maria Fareri Children’s Hospital in Valhalla, New York, where the family began preparing for a procedure to separate the twins.
The separation surgery was the most significant in a series of procedures for Ballenie and Bellanie performed at the hospital. Earlier procedures, which included gastrointestinal and reconstructive surgery work, helped prepare the girls for their unique separation surgery.
The reconstructive surgery involved the expansion of skin surface over the course of several weeks to be able to close the separation.
THE SIGNS OF CONJOINED PYGOPAGUS TWINS…
Pygopagus conjoined twins are where the two bodies are joined at the pelvis.
Only 17 percent of all conjoined twins are pygopagus.
Twins are connected at the sacrum, a triangular bone at the base of the spine, but have separate limbs.
They often share bladders, gastrointestinal tracts, and can be partly fused at the spinal cord.
Almost all pygopagus twins are female. Most male twins of this type are stillborn.
The surgical mortality rate is lower than in most conjoined twins at 23 percent.
IN IDENTICAL TWINS:
Identical twins are formed when one single is egg is fertilized but splits into two embryos.
Most conjoining occurs when the fertilized egg fails to separate completely.
IN FRATERNAL TWINS:
Fraternal twins are formed when two separate eggs are fertilized at the same time.
In very rare cases, stem cells search for like-stem cells on the other twin and, when found, fuse the twins together.
…AND HOW A TEAM OF 50 SEPARATED THEM
Over the course of 22 hours, surgeons separated conjoined 11-month-old twins Ballenie and Bellanie Comacho.
Doctors practiced on 3-D models of the little girls’ lower body, constructed from CAT scans and MRIs.
For several weeks before the operation, the twins underwent reconstructive surgery, which involved the expansion of skin surface to be able to close the separation.
First, doctors unraveled spinal cord connections as the girls were attached at the lower portion of the spinal cord.
Second, the structures at the sacrum – the bone where the girls were attached – were separated.
Next, plastic surgeons created the skin tissue environment necessary to close up the twins once they were separated.
Then, the soft tissue connecting the girls was separated.
Surgeons next divided the hypogastric artery branch, enabling proper blood flow to the twins’ legs.
Lastly, the genitourinary tracts of the girls (intestines, bladder, reproductive parts) were separated.
The twins will now spend several weeks recovering from surgery but questions remain about if they’ll be able to walk.
Multiple operations were performed over the course of the 22 hours.
Drs Whitney McBride and Pandya successfully separated the girls’ gastrointestinal connections and divided the hypogastric artery branch, enabling proper blood flow to the twins’ legs.
Next was the unraveling of the spinal cord connections and separating the structures at the sacrum.
Doctors then separated the soft tissue connecting the girls while plastic surgeons prepared skin to cover the open wounds.
Lastly, the girl’s genitourinary tracts – bladders and reproductive areas – were separated before they were closed up.
This is the second time that minimally invasive surgery has been used in the diagnosis and treatment of conjoined twins, giving surgeons a clearer image of how the digestive tracts were joined ahead of the procedure.
Dr Michael Gewitz, physician-in-chief, said: ‘The separation of Ballenie and Bellanie was a significant undertaking that was successful due to the skill, dedication and tireless preparation of a multidisciplinary team of pediatric specialists here at Maria Fareri Children’s Hospital.
‘The team met regularly for months, utilized new technologies for diagnoses, commissioned personalized, three-dimensional models of the girls’ anatomies and performed simulation procedures to ensure a successful outcome.
‘Ballenie and Bellanie can now live independent lives and we couldn’t happier to provide this ‘freedom’ to the girls and their parents, Laurilin and Abel.’
Dr Samir Pandya shows models of the girls’ anatomy. To prepare for the operation, the surgeons practiced multiple sessions using 3-D models of the little girls’ lower body constructed from CAT scans and MRIs
The girls’ skin surface had to be expanded before surgery so doctors could close them up once they were separated. The team successfully separated their gastrointestinal tracts, bladders, reproductive areas and the lower portion of the spinal cord
Laurilin and Marino share a hug after learning their daughters were successfully separated. The girls will be monitored for a few months in the ICU before being able to go home
Laurilin (pictured with Marino and the twins after the surgery) said: ‘I want to see my daughters healthy and independent. I want them to go to school, for them to play freely. Even if it’s in a wheelchair, anything, but with their freedom and independence.’
The girls will still be in the hospital when they celebrate their first birthday on February 4.
But, should no complications emerge, they will be back home to join their sisters Lina Bel, two, and Sheily, 10.
And although Marino joked that the first thing the family will do is go to the beach, Laurilin is looking even further ahead.
She told TODAY: ‘I want to see my daughters healthy and independent.
‘I want them to go to school, for them to play freely. Even if it’s in a wheelchair, anything, but with their freedom and independence.’