Conjoined Pinoy twins separated in New York

NEW YORK — Conjoined twins Carl and Clarence Aguirre have finally been separated and are now "strong and stable" after a marathon operation that stretched into the wee hours Thursday.

Doctors, nurses and technicians applauded after the successful operation that ended at 3:20 a.m. (yesterday afternoon in Manila), said Steve Osborne, a spokesman for the Children’s Hospital at Montefiore Medical Center here.

The two-year-old boys’ mother, Arlene Aguirre, burst into tears after being informed that she was "now the mother of two boys."

Dr. David Staffenberg, the boys’ plastic surgeon, said the boys were "strong and stable" after the 12-hour operation.

In Manila, Presidential Spokesman Ignacio Bunye said: "President Arroyo is very elated that the twins could now live normal lives."

Osborne said doctors had completed an incision around the skull of the twins, who were born joined at the top of their heads.

Doctors teased apart abutting portions of the boys’ brains after completing an incision around their skull, and the twins’ head-to-head operating tables were then slightly pulled apart, but still near one another so that the 16-person surgical team could continue to work side-by-side.

A hospital statement added that during the separation operation the twins’ major shared veins were divided and surgeons slowly teased apart the boys’ individual brains which tightly abutted each other.

Reconstruction of the boys’ skulls, a major project, is to be left for later.

Doctors have warned that it will be months before the twins’ conditions and the success of the separation can be fully assessed.

Doctors planned to reconstruct a membrane that covered the boys’ brains, and then cover their heads with skin, some of it from tissue expanders that had been planted beneath their scalps.

During the operation, doctors cut a fourth window into the skull and divided the last major vein the brothers shared, along with other blood vessels.

About six hours into that procedure, they decided the boys were doing well enough to continue.

Before the operation, most of the blood vessels around the brain had been cut and divided already, and the boys’ brains have been partially separated.

Arlene and her mother, Evelyn Aguirre, were at the hospital throughout the operation, getting occasional updates from the doctors.

They had sent the dark-haired boys into the operating room with tearful kisses.

Arlene placed a small figure of the Virgin Mary on her sons’ gurney, and it stayed with them, on an instrument cart, through the surgery, said Carmen Sarmiento, PAL Foundation executive director and her mentor in New York.

"She gave me a brief call to tell me the news, but she could barely talk because she kept on crying," Sarmiento said.

"In between her sobs she said she was waiting for them to come out of OR. I get the feeling she still doesn’t believe what’s happened.

"She has a nursing background so she’s very aware of all the complications that could still arise so she seems to be holding back on her happiness," she said.

Arlene, who turns 32 on Aug. 29, said her best birthday present ever will be to hold her sons in each arm.

PAL Foundation sponsored the trip of the Aguirres to New York.

The hospital statement said that because of the network of delicate veins located in the back of the brain, the work to isolate and separate these veins required a meticulous, methodical and time-consuming approach.

Wednesday’s operation was the fourth separation process for the twins since their arrival in New York from the Philippines with their mother on Sept. 10 last year.

Philippine Airlines flew the boys’ grandmother to New York last Saturday to support Arlene.

A news conference was scheduled at the hospital yesterday for the latest medical update on the twins.

Montefiore’s goal for the Aguirre boys, who have never been able to sit up, stand straight or look at each other’s face, was "viable, independent lives."

Over four major surgeries since October, the boys’ separate-but-touching brains were gently pushed apart and the tangle of blood vessels they shared were cut and divided.

Between surgeries, the boys were given time to heal and to adapt to their rerouted circulation systems.

Originally, veins near Clarence’s brain were doing much of the circulation work for both boys, but scans showed dormant veins on Carl’s side had "plumped up" and begun working in response to the surgery, lead surgeon Dr. James Goodrich said last week.

The twins, already veterans of three major procedures, went into the operating room around 7:30 a.m. for anesthesia and other preparatory work.

Doctors have taken a surgical approach employed only a few times before on conjoined twins, replacing the typical marathon two-day separation surgery with four shorter procedures over 10 months.

The doctors have donated their services, as have Montefiore and Blythedale Children’s Hospital in Valhalla, where the twins have been living between surgeries and receiving physical therapy.

The first surgery took place last October with a five-hour procedure to place balloons underneath the boys’ scalps in a process called tissue expansion. — AFP, Marichu Villanueva, Jose Katigbak in Washington