Conjoined twin boys undergo successful separation surgery

Carter and Conner, conjoined twin boys born Dec. 12, 2014, in Jacksonville, Fla., underwent a successful separation surgery on May 7, 2015. The 12-hour surgery was led by a team of highly skilled pediatric specialists that included Daniel Robie, MD, chief of pediatric general surgery, and Nicholas Poulos, MD, pediatric general surgeon, for Nemours Children's Specialty Care and Wolfson Children's Hospital.

The separation involved a 17-member surgical care team, including Stephen Dunn, MD, Division Chief of Solid Organ Transplant, for Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., who travelled to Jacksonville to assist the team in separating Conner and Carter's fused livers.

Preparing for the Separation
From the day after their birth to the morning of their final separation surgery, Carter and Conner received care in Wolfson Children's Hospital's Level III Newborn Intensive Care Unit (NICU) under the direction of Josef Cortez, MD, and Ma Ingyinn, MD, neonatologists with the University of Florida (UF) College of Medicine – Jacksonville.

The boys have been cared for by nearly 200 health care professionals that include neonatal and pediatric critical care nurses, pediatric respiratory therapists, rehabilitation therapists, Child Life specialists, pediatric chaplains and other health care disciplines.

Before Separation Surgery
On Dec. 13, 2014, the twins underwent emergency surgery to repair a potentially life-threatening condition called a ruptured omphalocele, in which their shared small intestine protruded through a weak area of the abdominal wall. Dr. Robie and Dr. Poulos positioned the babies' intestine inside their abdominal wall and placed a temporary mesh patch over it.

On Jan. 2, 2015, the boys underwent surgery to remove the temporary mesh and partially separate their shared small intestine, enabling them to feed orally. During this procedure, the pediatric surgeons discovered that the boys had two bile ducts that were fused. Conner and Carter's livers and bile ducts were left intact until the May 7, 2015, separation surgery.

Conjoined twins are extremely rare, with estimates ranging from one in every 100,000 births to one in every 200,000 births.

After Separation Surgery
Solange Benjamin, MD, medical director of the PICU, is leading a multidisciplinary team of UF College of Medicine – Jacksonville pediatric critical care physicians and Wolfson Children's Hospital pediatric critical care nurses, respiratory therapists and many other health care professionals during what is likely to be a sustained recovery.

Hope for the Future
"We are honored and thank the Mirabal and Brantley family for placing their trust in us to care for their beautiful baby boys," said Dr. Robie. "During this critical period on the road to recovery that is ahead of Carter and Conner, they have the wonderful support of their family and a skilled care team who are committed to their recovery, development and best possible health."

Carter and Conner's mother, Michelle, said, "We are so grateful to everyone who has taken care of our babies. We had so much confidence in them and they have been so good to us and to our family. We can't wait to take Carter and Conner home!"