Children's Hospital of Philadelphia Successfully Separates Conjoined Twin Boys

Amari and Javar Ruffin, who were born conjoined, are CHOP's 32^nd set of successfully separated conjoined twins

PHILADELPHIA, Oct. 9, 2024 /PRNewswire/ -- After nearly a year at Children's Hospital of Philadelphia (CHOP), conjoined twins Amari and Javar Ruffin were successfully separated by CHOP surgeons on August 21, 2024. The boys, who live with their family in Philadelphia, shared the lowest part of their sternum, diaphragm, abdominal wall, and liver. After a long medical journey, they have joined their siblings, Kaylum and Anora, along with their parents, Tim and Shaneka, at home.

Amari and Javar were diagnosed prenatally in CHOP's Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT) and spent 10 months in the hospital preparing for separation. After months of planning, a surgical team involving more than two dozen specialists, including surgeons, anesthesiologists, radiologists, nurses and many others, operated for eight hours to separate the boys. Once separated, the babies' abdomens were closed and rebuilt, using layers of mesh and plastic surgery techniques to stabilize each one.

"Separating conjoined twins always presents challenges because each set of twins is different," said Holly L. Hedrick, MD, a pediatric general and fetal surgeon CHOP. "We spend hours rehearsing the flow of surgery prior to the big day – even practicing how to transfer each baby to their own bed. We work collaboratively as a team, ready to combine our unique skills to achieve a safe separation and a chance for these babies to lead healthy and fulfilling lives."

Conjoined twins are rare, occurring roughly once in every 35,000-80,000 births, and CHOP is one of only a few hospitals in the U.S. with expertise in separating them. Since 1957, CHOP has performed 32 conjoined twin separations, the most of any hospital in North America. The Ruffins were born omphalopagus twins, meaning the babies face one another and are joined at the anterior abdominal wall from the xiphoid to the umbilicus.

When a routine ultrasound first revealed the boys were conjoined, Shankea and Tim, whose older children are patients at CHOP's Karabots Pediatric Care Center in West Philadelphia, knew where to turn. Within days, the couple met with a team that included Dr. Hedrick and Nahla Khalek, MD, a maternal-fetal medicine specialist in CHOP's CFDT. After a full day of prenatal evaluations including an ultrasound, MRI and fetal echocardiogram, tests revealed that separation was possible. This set in motion the plan for preparing the boys' first milestone: a safe birth.

The boys were born in CHOP's Garbose Family Special Delivery Unit (SDU) on September 29, 2023, weighing about six pounds collectively. The SDU is the world's first birth facility in a pediatric hospital specifically designed for mothers carrying babies with birth defects.

"The SDU was the ideal setting for the boys' delivery," said Dr. Khalek. "It's a lifesaving facility, offering unprecedented care and essential support to our most vulnerable infants and their families."

After birth, Amari and Javar spent time in CHOP's Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU), Infant Transitional Care Unit (ITCU) and Pediatric Intensive Care Unit (PICU). During the time prior to separation, they learned to feed, grow and adjust to life outside womb. Their anatomy was closely studied and Cassandra A. Ligh, MD, a pediatric plastic surgeon, placed tissue expanders to maximize the amount of skin and soft tissue available for their closure. 

Before the surgery, detailed imaging was completed, including fluoroscopy, MRI and contrast-enhanced ultrasound to define their anatomy.  On the day of surgery, a team of specialists made careful incisions down each boy's abdomen, sternum and diaphragm to access and separate the liver. During the liver separation, Edward Oliver, MD, a radiologist at CHOP, performed intraoperative ultrasound to map the vascular equator between the two fused liver masses and delineate vascular connections. With this part of the surgery complete, Amari and Javar were officially separated.

Dr. Ligh and the plastic surgery team then put a layer of absorbable mesh over their stomachs to hold their intestines and internal organs inside. They added a permanent mesh on top of that and closed it all with the natural lining of the boys' bodies to heal. They even created a belly button for each twin. An important component of Amari and Javar's care before and after separation included working with physical therapists, occupational therapists, speech language pathologists, and rehab medicine physicians in CHOP's Division of Physical Medicine and Rehabilitation to ensure they continued to achieve developmental milestones. Following surgery, the boys continued working with this group and began to practice turning over and crawling.

On Tuesday, October 8, following a year in the hospital, the family officially went home. They will continue weekly follow up care at CHOP.

"Seeing them each in their own beds was an indescribable feeling," recalls Shaneka. "It feels like we are beginning a new journey as a family of six. We are so grateful to CHOP for helping make this day possible and letting us start this next chapter."

Watch the video to follow along on the twins' journey or read their full story here.

About Children's Hospital of Philadelphia:  

A non-profit, charitable organization, Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as the Middleman Family Pavilion and its dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children's Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit https://www.chop.edu. 

Note to media:
The family has requested that all media requests be directed to CHOP Public Relations via Kaila Revello, senior public relations specialist, at [email protected] or 267-426-6054. Extensive video footage and photos available upon request.

Contact: Kaila M. Revello
Children's Hospital of Philadelphia
267-426-6054
[email protected]

SOURCE Children's Hospital of Philadelphia