Medicine: Separation Surgery

Carol Stubblefield, 24, wife of an Idaho beet farmer, knew she was going to have twins, but not until they were born a month prematurely in late June, did she know that they were joined (“Siamese”). The high-powered surgical squad that prepared to separate Jeanett Kim from Denett Lin Stubblefield at the University of Oregon Hospitals in Portland knew that it would be an immensely difficult task, but not until the operation was far advanced did they know how difficult.

Barium X rays had shown that the girls, joined for 5 in. down the middle of their chests and abdomens, had separate digestive tracts. Radiopaque dyes, injected into the bloodstream, had shown that each had two kidneys, and separate bile ducts. But blood was crossing the bridge between the twins. The important question: How much? Injected radioactive iodine 131 gave the answer through a scintillation counter: a forbidding 43%. The big remaining question was whether there were normal and separate blood-vessel connections to the liver. By operation’s eve the twins were amazingly healthy, with no indication of heart trouble (therefore, no blueness). They ate voraciously, and poked at each other so vigorously that they had to be fitted with mittens.

In the operating theater there was a quartet for each twin: senior surgeon and assisting resident, anesthesiologist and scrub nurse. Standing by were a pediatrician to direct replacement of blood and other fluids, a clinical pathologist, a cardiologist with a heart-lung machine, a bone-and-joint surgeon.

It was soon clear that the twins’ livers were joined. But before this problem could be faced, the surgeons separated the rib cages, found that the hearts were surrounded by a fused sac. They cut it so that Jeanett’s heart had a normal sac; Denett’s was open until they stitched it shut. Major blood vessels to the liver proved to be separate, but in cutting the bridge dividing the two organs, no fewer than 75 minor vessels had to be cut, and their bleeding stanched. Separated at last, each twin had her own quartet working independently—and with welcome elbow room—to close the fibrous covering that encapsulates the liver. After 4 hrs. 40 min., it was over. As a final esthetic touch, the surgeons had divided the twins’ common navel so that each girl, after skin grafting, would look normal—if she lived.

For ten days it was touch and go. First Denett seemed the weaker, then Jeanett sank alarmingly, with mucus threatening to choke her. Surgeons cut a hole in her neck and passed a silver tube into her windpipe to provide extra oxygen and speed drainage. Next day Jeanett went into unexplained spasms. Adrenaline-like drugs, and her own vitality, pulled her through that crisis. Last week, with infinite relief, the University of Oregon doctors pronounced the operation a success. Their greatest immediate danger past, both babies were doing well.