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Spunky toddlers, Eva and Erika Sandoval, born conjoined twins have a party to celebrate moving near their home 3 months after risky separation surgery

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Eva and Erika, twins born conjoined at the sternum celebrate moving to rehab facility near their home just weeks after risky separation surgery
The gestation was risky as well, Aida then-44 was urged to abort the little girls, she refused
She already had 3 adult children with husband Arturo then 49 
Two-year-old twins Eva and Erika Sandoval were attached from the sternum 
They shared a digestive system, uterus, liver, bladder, and a third leg 
The girls had 18-hour separation on December 6 after months of preparation left each girl with one leg
Their 3rd leg, which was fused, was used for reconstruction 
Erika, the smaller twin, was getting dangerously weak before the operation – but now she is improving faster than her sister 
On Friday, they were moved from their Palo Alto hospital to a Sacramento rehab facility much closer to their home in Antelope, Califor

It was one of the riskiest separation surgeries ever performed. The conjoined Sandoval twins have separation surgery at Stanford.
But now – three months after doctors untangled Eva and Erika Sandoval’s digestive system, a uterus, a liver, a bladder, a pelvis, and a third leg – the girls are leaving their Palo Alto hospital.
On Friday, the hospital released photos of the two-year-old twins eating cakes at a celebration party as they prepared to move to a rehab facility at UC Davis in Sacramento, near their hometown of Antelope.

They will stay there for a few weeks before finally being able to return home.
‘Erika and Eva look really great,’ said pediatric surgeon Gary Hartman, MD, professor of surgery at the Stanford University School of Medicine who led the 50-person team that separated the twins in a 17-hour operation and has closely monitored their recovery.
‘The girls have just blossomed in terms of personality,’ he said. ‘They’re very engaging and chatty.’
At a March 6 hospital farewell party, parents Art and Aida Sandoval were excited.
‘I’m over the moon,’ Aida said. ‘It’s still surreal seeing them separate, knowing that it’s still them as two individual bodies. Now we’re just waiting for their next chapter to begin, and the anticipation is indescribable.’
Eva was discharged from Packard Children’s on Thursday, March 9 after a three-month healing period in which her doctors closely watched the condition of the wound at her separation site.

After surgery: Aida, Arturo, and two of their three adult children embrace with joy after the operation1.pngAfter surgery: Aida, Arturo, and two of their three adult children embrace with joy after the operation

For a while, the plastic surgery team thought she might need a skin graft, but Eva’s wound is now healing well, and a graft will not be necessary.
Erika healed more quickly, allowing her to be discharged from Packard Children’s on February 13, when she left the hospital for the first time since the separation.
However, Erika was readmitted on March 4 to monitor some vomiting that was persisting over several days.

Aida and Arturo Sandoval 44 and he 49, view their miracle twins.jpg
Aida and Arturo Sandoval lovingly gaze at their miracle twins.

Aside from that bump in the road, for the last few months, both girls have been receiving physical and occupational therapy at Packard Children’s to help them learn new movement patterns that are suited to their individual bodies.
They have also participated in play therapy to help them adapt psychologically to the separation.
‘Neither girl seems to have trouble adjusting,’ said Packard Children’s child psychiatrist Michelle Goldsmith, MD, who has worked with the sisters. ‘They’re both rolling with what’s going on very well.’
The healing process has even had its share of light moments, Aida said.
‘The other day, Eva said “feet”, and I told her “foot”. I said, you have one foot and your sister has the other foot. And then I showed her that she has one leg, and that Erika has the other leg. And she pointed at Erika across the room and said ‘Erika took it! Erika took my leg!’
Before separation, the twins’ anatomy was like that of two people above the sternum, gradually merging almost to one below the diaphragm. They had a total of three legs, one of which was unlikely to ever be functional.
Tissue from the third leg was used as part of Erika’s reconstructive surgery, meaning that each twin now has one leg.
Both girls are now sitting on their own for short periods and will need to learn to use customized wheelchairs to move around.

two-year-old twins Erika and Eva Sandoval were reunited after separation
This is the moment twin sisters Erika and Eva Sandoval were reunited after an 18-hour long separation surgery

Because they each lack some pelvic bones on the side without a leg, it is unclear if they will be able to receive prosthetic legs in the future. But whether they use prosthetics or not, physical and occupational therapy will help them gain more independence.
Erika and Eva will continue to receive regular checkups with Hartman and other caregivers at Packard Children’s after they go home to Antelope.
‘They’re doing really well and they’re ready to go,’ Hartman said. ‘It’s a great thing for everyone on our team to see.’

Happy parents hang out with conjoined twins Erika and Eva Sandoval, who are reunited after separation

On December 6, in one of the riskiest separation operations ever performed, the twin girls were successfully separated.
Their parents Aida and Arturo made the harrowing decision to attempt separating them in 2016, as it became clear that with every month, more medical issues arose.
They had been hospitalized with dozens of urinary tract infections and countless cases of dehydration.
And it was getting worse with time.  The good news is that the girls have suffered no complications since separation.

Aida and her girls settle into their new apartment in Palo Alto in October. Aida has struggled to care for the twins in their temporary home while husband, Arturo, stayed back in the Sacramento area for work.jpgIn preparation Aida and her girls settled into a temporary apartment in Palo Alto, Calfor., in October. Husband, Arturo, stayed back in the Sacramento area for work for the period
Aida Sandoval on an outing with Eva and Erika on an outing  in Palo Alto before the surgery.jpgDivine guidance: Aida Sandoval, seen here during an outing with Eva and Erika on an outing in Palo Alto before the surgery, said her faith helped see her through trying moments
In a lengthy profile of the family, the Sacramento Bee last month described how the cost and scale of the operation – and pre-surgery, has taken such a heavy toll on the family.

Aida was urged to abort the little girls when she and Arturo surprisingly fell pregnant two years ago at the age of 44, Arturo was 49. Without hesitating, the religious couple, who already have three kids in their 20s, kept the pregnancy.
But life was becoming increasingly difficult for the girls.

Artoro holding his twin daughtersAida and Arturo Sandoval 44 and he 49, view their miracle twins Arturo {left] holding his twin daughters, {Right] Aida holds the girls

Aida said last month that she was confident the surgery would be a success, and that it would allow Erika – the smaller and weaker of the two – to grow into her own person. While Arturo continued his construction work near their home in Antelope, California, Aida had been forced to move to Palo Alto to live close to the hospital with the girls.

Aida said she maintained her faith: ‘You just have to remember that doctors tell you the worst.
‘I have faith in God, and I know that if it’s meant to be, it will be.
‘They want life, and they’re going to fight for it.’
She said she was confident that the surgery would be a success, and that it would allow Erika, the smaller and weaker twin, to grow into her own.
Eva was described as ‘the larger and more dominant twin’ and she carried them both around.

Eva and Erika before separation show off their amazing dexterityEva and Erika before separation show off their amazing dexterity.jpgEva and Erika before separation show off their amazing dexterity [Eva thrust forward with two arms and one thick leg, while Erika scrambled to support herself on spaghetti-thin limbs, sometimes giving up entirely and letting herself be dragged along,’] reporter Sammy Caiola observed.

Prior to the surgery, Dr Hartman said Eva would likely keep their bladder, while Erika would get a colostomy bag.
Erika, the weaker twin, was expected to keep their third leg while Eva would get the other two.
Both were expected to be missing vital body parts; and both needed significant reconstruction of their lower bodies.
The surgeons estimated the operation carried a 30 percent risk that one or both of them would die – largely due to the fact that they shared a tangled skeletal system, with many shared and tangled blood vessels.
‘This is a worrisome number because in most cases doctors only perform with a tenth of a percent chance of fatality,’ their parents Aida and Arturo wrote on their Facebook page before the surgery.

The team used intricate 3D-printed models showing the girls’ entangled skeletal structures, which enabled the surgeons used to plan ahead of the actual operation. The pelvis (left) was the biggest obstacle, since it was entwined and tangled with many shared blood vessels.

It was reported as one of the most complicated procedures surgeons at Lucile Packard Children’s Hospital Stanford have ever faced so complicated that the pre-op took over a year as the operation kept getting pushed back

Aida Sandoval rests twins Eva and Erika on her shoulders during a hospital visit.jpgAida Sandoval rests twin daughters Eva and Erika on her shoulders during a hospital visit. The girls were hospitalized for seven months after birth,followed by dozens of medical appointments and emergency room visits.
 ‘It’s hard to see the numbers and find comfort on the odds.

‘But … from the beginning our girls have superseded the doctors expectations of life and will continue to show us their strength.’
Ahead of the operation, Dr Hartman told the Sacramento Bee the biggest concern was preventing blood loss when severing the liver and the pelvic bone.
Their operation is one of the most complicated procedures surgeons at Lucile Packard Children’s Hospital Stanford have ever faced – so complicated that the operation keeps getting pushed back.

Eva [Left], and Erika [Right], pictured arriving at the hospital for their landmark separation the surgery in January
Eva [Left], and Erika [Right], pictured arriving at the hospital for their landmark separation the surgery in January

Surgeons spent the last few months inserting tissue expanders, a common tactic in separation of conjoined twins.
It was a way of stretching the skin gradually so that, when it came to the reconstruction surgery, they have more to move and manipulate.
The team released photos from inside the operation, and pictures of the 3D-printed models of the girls’ shared body parts, which they used to practice for months.
‘We’re so happy they did well during the actual separation procedure and it went smoothly,’ Gail Boltz, clinical professor of anesthesiology, said.
Matias Bruzoni, Dr Hartman’s co-surgeon who made the final cut of the skin in the separation, explained how the team working ‘little by little’ from the upper chest down to the shared leg.
The surgery was challenging because they shared much of their lower body and had one liver, one bladder and three legs.

Dr Hartman explained: ‘It doesn’t matter if you get them separated if you cant get them reconstructed and get them closed.
‘Matias and Jim [Gamble, the orthopedic surgeon who guided the separation of the pelvis] got us through the pelvis and cut the skin.
‘As Matias says, it’s the most anticlimactic thing. You’ve been through the whole separation then you just have to cut that last bit of skin, and they’re the heroes.
It doesn’t matter if you get them separated if you cant get them reconstructed and get them closed. The reconstructive guys are really the heroes.

In the opinion of Lead surgeon Dr Gary Hartman – ‘The reconstructive guys are really the heroes.

‘And the proof of that is Erika, who was and is the smaller twin. We were very concerned about her pre-surgery because she kept getting smaller. The more calories we gave her, Eva would get bigger.
‘But because of the way she was reconstructed, she is getting stronger and moving faster than her sister.
‘That is down to the creativeness of the reconstructive surgeons.’

'It's been a dream come true': Aida Sandoval wept next to her husband last week as they thanked the surgical team that separated their two-year-old daughter Eva and Erika
Aida Sandoval [right] gets emotionla standing next to her husband last week as they thanked the surgical team that separated their conjoined twin daughters, Eva and Erika

Donations for Eva and Erika can be sent to their parents Aida and Arturo Sandoval  via YouCaring

 

 

 

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