Durham County

Duke Medical Center separates conjoined twins

Duke Medical Center team successfully separates conjoined twins

Team of doctors' seven-hour operation is a success and the 8-month-old boys go home to Dunn, NC, after only a week in the hospital. (Surgery video courtesy of Duke Medical Center News Service)
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Team of doctors' seven-hour operation is a success and the 8-month-old boys go home to Dunn, NC, after only a week in the hospital. (Surgery video courtesy of Duke Medical Center News Service)

While she waited for her 8-month-old twin boys to go into surgery at Duke University Medical Center, Vanessa Covington was told by doctors that she might face a nightmarish choice. Her twins were conjoined at the abdomen, sharing a single liver, and surgeons, preparing to separate the boys, were ready for a laundry list of potential complications. One scenario: the surgery would result in one functional liver, and Covington would have to pick which one of her children would live.

Instead of facing that choice, she will be taking the two boys to Myrtle Beach next weekend for a family reunion. The June 18 separation surgery, which lasted about 10 hours and required two operating rooms and some of Duke’s most experienced surgeons, went off without a hitch. Covington walked out of the hospital Friday afternoon with her two boys. They are expected to live healthy, normal lives.

The surgery was the first separation of conjoined twins at Duke, and the first in North Carolina in about 15 years. The births are very rare, according to head pediatric surgeon Henry Rice, who led the surgery. He said the health and rapid recovery of the two young boys is also uncommon for such an involved surgery.

They face relatively minor complications from living with abdomens conjoined for nearly nine months of their lives. They have some spinal curvature, Rice said, but added that the condition is likely to heal on its own, or with some physical therapy. He does not anticipate a subsequent surgery anytime soon.

“As far as I can tell, they should have relatively healthy, productive, very normal lives,” Rice said. “Their development should be on par with everyone else.”

Preparing for birth

The boys had highly unconventional early lives. Covington, 30, who lives in Dunn, was in continuous contact with doctors at Duke before and after the birth, and came into the hospital often, especially as the surgery drew near.

The children stayed in the hospital for 21 days after they were born, in late September. Doctors waited until this month to conduct the surgery because the boys had to be strong enough to survive the procedure.

When she first learned of the condition, after a sonogram conducted eighteen weeks into her pregnancy, Covington, a single mother who also has a 9-year-old daughter, was devastated, especially concerned that the twins might not survive until birth.

“I cried for like a week,” she said. “I had seen it on TV but I never thought it would be me.”

The twins were born three weeks early and without further complications. Covington did not take the boys in public, to avoid prying questions. At home, they required special care and attention. She had to turn them over often to prevent their weight from injuring one, and she had to carefully bathe them by hand.

She received support from family and friends, and some hired health care support, she said.

Preparing for surgery

The separation surgery, and preparation for it, required many hours of planning and cooperation across different departments at Duke Medicine, Rice said. Radiologists prepared 3-D models of the boys’ shared liver in order to aid abdominal transplant specialist Dr. Debra Sudan in her effort to turn it into two functional livers for the two boys.

Prior to the surgery that required two full teams of anesthesiologists, plastic surgeons inserted a skin expander to ensure that each boy had sufficient skin to seal the incision after the surgery.

The hospital estimated the total cost of the boys’ care at over $200,000. Covington’s medical expenses are covered by Medicaid.

Rice, who considers himself to be public health-minded, said the operation allowed for two full lives free of disability, a scale of benefit rare in medicine.

“It takes a lot of resources to get these kids separated,” Rice said. “But compared to what we spend money on usually, this is a much more efficient use of our dollars.”

Covington said she is relieved and ready to get the boys home. Many of her family members have not seen the curly-haired boys yet. They will get a chance at the family reunion in Myrtle Beach.

“I’m just ready to get home, and get to my family, and get to my little girl,” Covington said.

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