Maria and Teresa Tapia

Maria and Teresa Tapia (born April 8 2010) were conjoined twins born in the Dominican Republic. The twins were joined by their lower chest and abdomen and were therefore classified as omphalopagus sharing a liver, pancreas, and a small portion of their small intestine. On November 7, 2011, the twins underwent a successful separation surgery at the Children's Hospital of Richmond in Virginia.^[1]

Conjoined Twins

For every 200,000 live births, conjoined twins are born. Conjoined twins are identical and of the same sex one hundred percent of the time and are more common in females than in males. For surgical separations the survival rate of at least one twin surviving is approximately 75%.^[2]

Background

Separation surgery was critical to this set of twins as 88 percent of the blood flow from the liver was transmitted to Teresa leaving Maria approximately 20 percent smaller due to a lack of nutrients. The Dominican Republic does not have access to the medical tools needed to separate the twins. Upon learning about the twins, World Pediatric Project stepped in and helped.

World Pediatric Project

The World Pediatric Project is a non-profit organization that heals critically ill children in developing nations that may not have access to quality health care tools or procedures. WPP was founded in 2001 as the International Hospital for Children with a mission "to link worldwide pediatric surgical, diagnostic and preventative resources to heal critically ill children in developing countries." The International Hospital for Children and a non-profit organization based in St. Louis merged in March 2011 and became World Pediatric Project.^[3] WPP heard about the twins' story through their partners in the Dominican Republic and as a result brought the twins and their mother to the United States to receive surgery performed by Dr. David Lanning.

Surgery Team

The surgery team included a variety of doctors and surgeons to ensure the twins' safety during and after the procedure. There were a variety of departments from plastics to anesthesiology represented. The surgeon team that completed the 20-hour surgery was composed of the following:

The Separation Team

• Jennifer Rhodes, professor of the Department of Surgery Division of Plastic and Reconstructive Surgery at VCU, and director of the Children’s Hospital of Richmond Center for Craniofacial Care
• Robert Fisher, M.D., professor of surgery and director of liver transplant program
• Claudio Oiticica, M.D. associate professor of surgery.

Dr Lanning also worked alongside the Division of Pediatric Anesthesiology. The Division of Pediatric Anesthesiology played a significant role in the process that leading up to as well as the actual separation surgery.^[4]

The Anesthesia Team

• Jay Shapiro, M.D., professor
• Jeanette Kierce, M.D., assistant professor
• Arkadiy Dubovoy, M.D., assistant professor
• James Dore, M.D., assistant professor
• Iolanda Russo-Menna, M.D., assistant professor, pediatric anesthesiology

Surgery

With a team of 45 surgeons, the separation surgery took approximately 20-hours. The separation process started on November 7, 2011 at 6 am. This was the first time that a surgery of the type was performed at the Children’s Hospital of Richmond.^[5] The surgical team divided the pancreas, the liver, as well the organ systems that the twin girls shared. Lastly, the surgical team rebuilt the abdominal walls of the twins.^[6]

Recovery

The girls underwent a six-week period for physical therapy and recovery.^[7] Maria and Teresa are now able to walk independently and are starting to form their own individual personalities. The girls were able to return to the Dominican Republic and often return to the United States for follow-up care.

Dr. David Lanning, M.D., Ph.D.

Background at VCU Dr. David Lanning acquired both his M.D. and Ph.D. at Virginia Commonwealth University. In 2002 he finished his general surgical training. His pediatric fellowship was completed at the Children’s Hospital of Michigan. In 2004 he turned to VCU to work. Now Dr. David Lanning practices as an associate professor of Surgery and Pediatrics in Surgery. Now, Dr. Lanning practices both General and Thoracic Pediatric Surgery.^[8]

Background with the World Pediatric Project

• Since 2007 Dr. Lanning has volunteered with World Pediatric Project.
• The first mission trip that Dr. Lanning attended with World Pediatric Project was in the countries of St. Vincent and Grenadines. Every year Dr. Lanning visits these countries and performs surgeries to heal children that are in St. Vincent as well as the nearby by area.

References

• Burkett, Malorie, and Shira Cantor. "VCU Releases Formerly Conjoined Twins from Hospital." VCU News. VCU, 2 Dec. 2011. Web. 1 Feb. 2015. http://news.vcu.edu/article/VCU_Releases_Formerly_Conjoined_Twins_from_Hospital
• CNN, Library. "Conjoined Twins Fast Facts." CNN Wire 11 July 2013: Newspaper Source Plus. Web. 23 Feb. 2015.
• "Conjoined Twins Maria & Teresa Tapia: Before and after." CBSNews. CBS Interactive. Web. 5 Feb. 2015. <http://www.cbsnews.com/pictures/conjoined-twins-maria-teresa-tapia-before-and-after/>.
• "David Lanning, M.D., Ph.D., Pediatric Surgery." - Virginia Commonwealth University Health System. Web. 20 Feb. 2015. <http://www.vcuhealth.org/?id=1107&sid=1>.
• "Lexic.us." Omphalopagus: Definition with Omphalopagus Pictures and Photos. Web. 20 Feb. 2015. <http://www.lexic.us/definition-of/omphalopagus>.
• "Maria and Teresa’s Story | World Pediatric Project." World Pediatric Project. Word Pediatric Project. Web. 3 Feb. 2015. <http://www.worldpediatricproject.org/who-we-help/children/maria-teresas-story-2/>.
• Press, Associated. "'The Individuals They Were Born to Be!' Conjoined Twins Successfully Separated after 20-hour Surgery in Virginia Hospital." Daily Mail. Associated Newspapers. Web. 21 Feb. 2015. <http://www.dailymail.co.uk/news/article-2059189/Conjoined-twins-Maria-Teresa-Tapia-separated-20-hour-surgery-Virginia-hospital.html>.
• Smith, Tammie. "Conjoined Twins Surgically Separated at VCU Return to Richmond a Year Later." Richmond.com. Richmond Times Dispatch, 2 Nov. 2012. Web. 8 Feb. 2015. <http://www.richmond.com/business/article_e0988d2c-e7ff-503f-9c48-9d6db62baffc.html>.