“Separate but connected: The moving journey of twins Lily and Addy”

Conjoined twins Addison (Addy) and Lilianna (Lily) Altobelli were successfully separated by surgeons at Children’s Hospital of Philadelphia (CHOP) on October 13, 2021. The girls were born connected in the abdomen and chest, a condition known as twinning thoraco-omphalopagus. , meaning they shared a liver, diaphragm, chest, and abdominal wall.

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Addy and Lily’s journey began when they were diagnosed prenatally at their 20-week ultrasound. Before that appointment, parents Maggie and Dom Altobelli had assumed they were having one baby, but the ultrasound image showed that Maggie was not only carrying two fetuses but they were also attached at the abdomen.

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Conjoined twins are rare, occurring in only 1 in every 50,000 births. The couple was referred to CHOP for further evaluation, as the hospital is one of the few in the country with experience separating conjoined twins. More than 28 pairs of conjoined twins have been separated at CHOP since 1957, the most of any hospital in the country.

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The couple met with specialists from CHOP’s Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. Doctors discovered that although the girls shared a chest and abdominal wall, diaphragm and liver, the twins had separate, healthy hearts. Their shared liver was also large enough to split between them, making them excellent candidates for separation surgery.

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After months of planning for a high-risk cesarean delivery, led by Julie S. Moldenhauer, MD, Addy and Lily were born on November 18, 2020 in Garbose’s Family Special Delivery Unit (SDU), the birth unit for CHOP inpatients. . They spent four months in the Newborn/Infant Intensive Care Unit (N/IICU), followed by six months in the Pediatric Intensive Care Unit (PICU). CHOP plastic surgeon David W. Low, MD, inserted skin expanders to stretch the girls’ skin in preparation for separation surgery. Like small collapsible balloons, skin expanders gradually expand through injections, stretching the skin slowly over time so that each girl has enough skin to cover the exposed chest wall and abdomen after separation.

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On October 13, 2021, after months of preparation, Addy and Lily underwent a 10-hour surgery and were officially separated at 2:38 p.m. The surgical team, led by Dr. Holly Hedrick, included more than two dozen specialists, including general surgeons. , anesthesiologists, radiologists, cardiothoracic surgeons and plastic surgeons. Once the twins were separated, the surgical team reconstructed each girl’s chest and abdominal wall. Stephanie Fuller, MD, a cardiothoracic surgeon, ligated the girls’ patent ductus arteriosus and made sure both of their hearts were in the correct position and working well. Plastic surgeons placed two layers of mesh, one temporary and one permanent, over the twins’ abdominal and chest walls and then covered them with skin that had been stretched for months.

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On December 1, 2021, the Altobellis finally flew home to Chicago, one twin at a time, with one parent each, after living in Philadelphia for over a year. The twins spent two weeks at Lurie Children’s Hospital under the care of the medical team that will support them closer to home. The girls were discharged just in time for Christmas and when they arrived home they found their garden decorated by their neighbors. They spent the holidays together at home as a family of four.

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