As conjoined twins recover from a second surgery, doctors look for them to grow stronger, healthier

Charlie Patton
Carter and Conner Mirabal remain in the Newborn Intensive Care Unit at Wolfson Children's Hospital.

The question which left 23-year-old Michelle Brantley in tears was about holding her babies, something she has not been able to do since the conjoined twins were born shortly before midnight on Dec. 12.

Monday Carter and Conner Mirabal remained in the Newborn Intensive Care Unit at Wolfson Children's Hospital, recovering from a surgical procedure performed Friday by a team of more than 20 medical professionals. It was the second procedure the twins have undergone since their birth. The first was performed when they were just hours old.

Now doctors hope they can wait several months before doing surgery again, said Daniel Robie, a pediatric surgeon with Nemour's Children's Clinic, who is chief of pediatric surgery at Wolfson. Robie and Nicholas Poulos, a Nemour's pediatric surgeon, headed the surgical team for both procedures.

During a press conference at Wolfson Monday, Brantley said she and the twins' father Bryan Mirabal first learned the twins were conjoined in late July during routine tests.

"It was shocking," she said. "It took forever to wrap our heads around it."

She has been visiting the intensive care unit daily but hasn't been able to interact with her children, who will probably remain hospitalized until after surgery to separate them is performed.

The birth by Caesarean section at University of Florida Health Jacksonville came after 36 weeks of gestation, making the infants slightly premature (a 39 week gestation period is considered full-term).

The birth of conjoined twins is an extremely rare occurrence, something a large children's hospital might encounter "once every 10 or 20 years," Robie said duringMonday's press conference.

"This is a once in a career type clinical scenario," he said.

The Mirabal twins are believed to be the first conjoined twins ever treated at Wolfson, which means they may well be the first ever treated in Jacksonville, said Michael Aubin, Wolfson's president.

Carter and Conner Mirabal are thoraco-omphalopagus twins, the most common form of conjoined twins. They were born sharing an intestine. They have separate livers and bile ducts but their livers and bile ducts are fused and must eventually be surgically separated.

"The good thing is that their hearts are separate," Robie said. "That's a huge positive."

The first surgery they underwent, on Dec. 13, was to treat a potentially life-threatening condition called gastroschisis.

"The abdominal wall was not fully developed," Robie said, likening the tissue that covered the children's intestines and liver to a wet tissue paper.

Surgeons covered the area with a temporary mesh patch. After three weeks, that patch needed to be removed, one of the factors that prompted Friday's surgery. During that procedure, surgeons also partially separated the shared small intestine, creating a small intestine for each twin.

The twins are no longer relying on a ventilator and should soon begin receiving nutrition and hydration orally rather than intravenously, said Josef Cortez, a neonatologist with University of Florida College of Medicine - Jacksonville, who is the primary neonatologist for the twins in the Wolfson Newborn Intensive Care Unit.

"They're really doing well after the surgery," Cortez said.

Now the goal is for Carter and Conner to grow larger, healthier and stronger before surgeons attempt to completely separate them, Robie said.

One concern, Robie said, is that Conner seems to be flourishing, his system "winning the battle" for the shared nutritional resources.

"So far they have not forced our hand," he said. "...We want them to eat and grow and behave."

"They are doing wonderful on their own," Brantley said. "We're taking it day by day.

Charlie Patton: (904) 359-4413