Painfully, the team at Texas Children’s Hospital in Houston informed the family Hope would need another eight weeks to heal from the operation that divided their liver, diaphragm and part of their heart.
One-year-old twins Anna Grace and Hope Elizabeth Richards were conjoined for the first year of their life, and thrived off each other’s company after their risky separation surgery in January this year.
But for the past two months, the girls have been several miles apart.
While Anna Grace was healthy enough to leave the hospital on March 2, Hope’s condition was fragile.
On Wednesday, after a staggering 482 days in hospital, parents Jill and Michael are finally able to take little Hope home with her sister, and older brothers Seth and Collin.
‘This is the moment it all feels real,’ Jill said. ‘Our family is eternally thankful for the doctors, nurses, child life specialists, physical therapists and many others at Texas Children’s who took incredible care of our precious girls.’
Anna Grace and Hope Elizabeth Richards were born attached at the chest in December 2016 and underwent a separation surgery in January. Anna, right, was discharged on March 2, and Hope, left, was discharged on Wednesday
For the first year of their lives, the girls shared a liver, diaphragm and part of their heart
Hope was all smiles on Wednesday when she was discharged after 482 days in the hospital
Baby Hope was escorted out of the hospital with the help of her parents and staff members
Jill Richards, center, said the family is thrilled to have the girls home in North Texas with their father Michael (right) and brothers Seth and Collin (left)
Anna Grace and Hope Elizabeth Richards were born attached at the chest and abdomen on December 29, 2016 and spent their first year of life in a neonatal intensive care unit, sharing a liver, diaphragm and part of a heart.
The twins’ parents knew long before their daughters were born that they would be conjoined.
An ultrasound revealed that their daughters were thoraco-omphalopagus twins, meaning they shared large portions of their torsos.
The family could not be certain until after their birth that their daughters could ever live life apart.
After Anna and Hope were delivered by cesarean-section at over 35 weeks, weighing a combined nine lbs 12 oz, they were kept at the hospital to assess their strengths and what vital organs they shared.
Hope and Anna are pictured as nurses prepare them for the surgery that took seven hours
Jill is pictured holding the conjoined twins just before they underwent the extensive surgery
Dr Ed Buchanan, pediatric plastic surgeon at Texas Children’s, stops by to admire the girls
The girls reunite after almost two months apart on the day Hope finally got to go home
Two nurses are pictured saying goodbye to Hope before she was discharged on Wednesday
Hope’s parents beam as she is lifted into the ambulance to be escorted home to North Texas
About one in every 200,000 live births in the world are conjoined twins. Though there are far more hospitals and surgeons equipped to separate them now than in decades past, about 35 percent of these babies only live a day after their birth.
Conjoined twins are very rare, making the causes behind the condition difficult to study and as-of-yet unclear.
Twins form when a single fertilized egg splits early in embryonic development.
But this process is not instantaneous, and on the rare occasions when the egg does not fully split, the two fetuses become conjoined, growing shared organs and body structures.
Their bodies may be linked at nearly any point, though thoraco-omphalopagus twins, like Anna and Hope, are the most most common form, making up about 28 percent of all conjoined twins.
Doctors are unsure why, but conjoined twins are usually girls – about 70 percent of the time – and tend to have better survival rates than boys do after birth.
A team of 75 doctors and nurses operated for seven hours to separate Anna and Hope
One of the teams of doctors that operated on Anna and Hope makes an incision in the girls’ shared skin, an early step in their separation
WHAT ARE CONJOINED TWINS?
Conjoined twins occur when siblings have their skin or internal organs fused together.
It affects around one in 200,000 live births.
Conjoined twins are caused by a fertilised egg beginning to split into two embryos a few weeks after conception, but the process stops before it is complete.
The most common type is twins joined at the chest or abdomen.
Separation surgery success depends on where the twins are joined.
Doctors can only tell which organs the siblings share, and therefore plan surgery, after they are born.
At least one twin survives 75 per cent of the time.
Twin girls also tend to be more resilient to the stresses of separation surgeries, and now, at least one twin survives separation about 75 percent of the time, though rates vary depending on what organs and structures the babies’ share.
Success rates for separating twins joined at the spine, for example, are estimated to be as high as 68 percent.
The first separation surgeries were performed in the 1950s, but the operation remains a steep challenge to even the most experienced surgeons.
For many sets of conjoined twins, separation is simply not an option because they share too many essential organs and blood vessel connections.
For still other families, separation may cost one twin their life, but give the other a better chance at survival and a more viable future.
Fortunately for the Richards family, both Anna and Hope had good chances of surviving the surgery, so doctors went to work preparing the pair of babies from the first days of their lives.
The process of separating Anna and Hope would take nearly another two agonizing years after their birth.
In November, surgeons operated on the baby girls to place tissue expanders in preparation for their separation.
Jill (left), Micheal (center), and Collin and Seth Richards marvel at Anna, resting in her own bed for the first time alongside one of the surgeons that operated on the twins, Dr Oluyinka Olutoye
Finally, after a year of round the clock care from three teams of nurses and neonatal specialists, the girls’ tiny bodies were ready.
A team of 75 surgeons, specialists and nurses that had been practicing the delicately coordinated operation for months performed a surgery to separate their heart, diaphragm and liver, and to give separate blood sources to the newly-formed two hearts.
Anna and Hope’s surgery required cardiologists to split the parts of their hearts they shared, plastic surgeons to carefully place the once shared tissue over the newly-individual bodies.
Among the steepest challenges of a separation surgery is the rerouting of blood vessels to make sure that neither twin loses too much blood in surgery, and that all of their organs have consistent supply throughout their new lives apart.
This was particularly true for Anna and Hope, who shared a large blood vessel connecting their partially-conjoined heart.
‘Through simulations and countless planning meetings, we were able to prepare for situations that could arise during the separation,’ said Dr Larry Hollier, the surgeon-in-chief and chief of plastic surgery at Texas Children’s Hospital.
‘We are thrilled with the outcome and look forward to continuing to care for Anna and Hope as they recover,’ he added.
Anna and Hope spend their final moments conjoined as they are wheeled into surgery
Hope Richards rests, able to sleep on her back for the first time after being separated from her twin sister
The surgeons referred to a 3D model of the twins’ skeletons to strategize their next moves during surgery