After sharing much of their lower bodies since being born conjoined more than two years ago, Antelope twins Eva and Erika Sandoval will undergo a rare surgery starting Tuesday morning at Lucile Packard Children’s Hospital Stanford with the hopes of beginning their independent lives.
The girls have separate brains and hearts but share a liver, bladder and some of their digestive system as well as a third leg. Despite the challenges of living in their 42-pound, seven-limbed body, the energetic twins have learned to walk, talk and play together. Still, parents Aida and Arturo Sandoval as well as the doctors at Stanford say the surgery is necessary for their long-term health as well as their future freedom and mobility. Doctors estimate a 30 percent chance that one or both twins won’t survive the complicated procedure.
The operation will involve 50 hospital staff members from plastics, orthopedics, urology and other departments. It will begin around 6 a.m. Tuesday and is expected to last between 18 and 24 hours. Surgeons will first anesthetize the twins before cutting through organs and bone, all the while consulting 3-D printed models of the girls’ fused pelvis and networks of blood vessels.
The biggest threat to the twins’ survival is blood loss, which is most likely to occur during the splitting of the liver or of the pelvic bone, said lead surgeon Dr. Gary Hartman, who has successfully separated two other sets of conjoined twins at Lucile Packard.
“The challenges technically are going to be splitting the liver, but we have good tools to do that, and it looks like we have a favorable anatomy,” Hartman said. “Down in the pelvis, it’s going to be sorting out how these structures all drain to the outside.”
Once separated, both girls will be wheeled into separate operating rooms for extensive reconstruction from the abdomen down. Whichever twin does not keep their shared bladder will likely require a colostomy bag for kidney drainage. Surgeons have not yet decided if the third leg will go to one of the girls or if it will be used for skin grafting.
Mother Aida says she’s enjoying her daughters in their last few days living in one ever-busy body. The stronger twin, Eva, is still the more vocal one and often drags her sister along as she crawls. Erika, however, never stops vying for her mother’s affections.
“When they get separated, it’s going to be like the loss of the one little body,” Aida said. “But it will be the birth of two little independent individuals.”
Still, the past week hasn’t been the same for the Sandoval family with the long-awaited operation date looming, Aida said.
“These last few nights, I feel the girls sense something is going to happen because they wake up crying,” she said. “They keep saying, ‘Mommy, hold you,’ which basically means they want me to hold them.”
In September, surgeons inserted three balloon-like tissue expanders into the twins’ sides and back to stretch skin for post-surgical grafting. The wounds left by the surgery would otherwise be large and vulnerable to infection, said pediatric reconstructive surgeon Dr. Peter Lorenz.
After their August 2014 birth, the twins spent their first seven months at the Stanford hospital before joining Aida and Arturo in the Antelope home where they raised their three older children, now grown and living on their own. In October, Aida, Eva and Erika moved into a $6,000-a-month apartment in Palo Alto to live closer to the medical staff at Lucile Packard, while Arturo stayed in the Sacramento area where he’s employed as a heavy equipment mechanic. The family has started a page on the crowdfunding site YouCaring to raise money for rent and medical expenses, in addition to hosting other fundraisers.
The parents said they have faith that their “little miracles” will continue to pull through. As few as one of every 200,000 births produces conjoined twins, and about half of them arrive stillborn, with 35 percent surviving only one day, according to the University of Maryland Medical Center.
“I look forward to our new journey and what’s going to be out there for us and all the challenges that we’re all going to face together and overcome,” Aida said. “We’re going to fight through them.”
Just days before surgery, Aida presented to Eva and Erika two teddy bears that she had bound together at the leg with a sock and white tape. She pulled them apart gently, exposing two taped-up nobs where the joined leg once protruded. Aida sat the bears separately but near each other on a table and turned to her daughters.
“That’s you!” she told the twins, who watched perplexed from their double stroller. “Dr. Hartman will perform his magic, and then you’ll be two.”
The Sacramento Bee will have exclusive coverage of Eva and Erika's risky separation surgery as it unfolds. Watch for updates Tuesday and Wednesday at sacbee.com.