In an extraordinary feat of surgical skill and medical expertise, conjoined twins Addison (Addy) and Lilianna (Lily) Altobelli underwent a groundbreaking separation procedure at the Children’s Hospital of Philadelphia (CHOP) on October 13, 2021. Born joined at the abdomen and chest, a condition termed thoraco-omphalopagus twins, Addy and Lily shared a liver, diaphragm, chest, and abdominal wall.
The twins’ remarkable journey commenced during a routine 20-week prenatal ultrasound, revealing an unexpected twist in their parents’ lives, Maggie and Dom Altobelli. What was assumed to be a singular pregnancy turned out to be the conception of two fetuses fused together at the abdomen.
Conjoined twins are an exceedingly rare occurrence, appearing in just about 1 in 50,000 births. This unique situation led the Altobellis to CHOP, a distinguished institution with a legacy of successfully separating conjoined twins. Since 1957, CHOP has overseen the separation of over 28 pairs of conjoined twins, a testament to their pioneering expertise in the field.
The Altobellis collaborated with specialists from CHOP’s Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. In a momentous revelation, doctors discovered that while Addy and Lily shared crucial components like the chest and abdominal wall, diaphragm, and liver, they possessed separate and healthy hearts. The twins’ sizeable shared liver lent itself to division, rendering them exceptional candidates for the complex separation surgery.
After meticulously planning a high-risk C-section delivery, led by the skilled hands of Dr. Julie S. Moldenhauer, Addy and Lily made their entrance into the world on November 18, 2020, within the Garbose Family Special Delivery Unit at CHOP. Their ensuing journey saw them spending four months in the Newborn/Infant Intensive Care Unit (N/IICU) followed by an additional six months in the Pediatric Intensive Care Unit (PICU). As part of the preparatory process for separation, CHOP plastic surgeon Dr. David W. Low implanted skin expanders to gradually stretch the girls’ skin, ensuring there would be sufficient coverage for their chest and abdominal walls post-separation.
The culmination of months of meticulous preparation arrived on October 13, 2021, when Addy and Lily underwent a painstaking 10-hour surgery that culminated in their official separation at 2:38 p.m. Spearheaded by Dr. Holly Hedrick, the surgical team consisted of over two dozen specialists encompassing general surgeons, anesthesiologists, radiologists, a cardiothoracic surgeon, and plastic surgeons. Following the successful separation, the team meticulously reconstructed each girl’s chest and abdominal walls. Dr. Stephanie Fuller, a cardiothoracic surgeon, ensured proper heart positioning and functionality by ligating the girls’ patent ductus arteriosus. The plastic surgery component entailed the application of both temporary and permanent mesh layers over the exposed areas, which were then enveloped with stretched skin that had been gradually expanded over months.
The 1st of December, 2021 marked a monumental day for the Altobelli family as they finally embarked on their journey home to Chicago. The twins, accompanied by one parent each, were discharged from CHOP after more than a year in Philadelphia. Their transition was eased by a two-week stay at Lurie Children’s Hospital, a vital step towards their ongoing care. The twins were released just in time for the holiday season, arriving home to a heartwarming surprise as their neighbors had adorned their yard with festive decorations. As a family of four, they celebrated Christmas in the embrace of their own abode, symbolizing the triumphant culmination of an extraordinary medical odyssey.
