Conjoined Twins Successfully Separated following 18-Hour Surgery

SEATTLE, Wash. – 18 hours of surgery. A team of 30-plus healthcare providers. And months of planning and preparation.

Seattle Children’s is pleased to announce that after performing a successful surgery to separate 15-month-old conjoined twins, the toddlers are thriving at home, receiving occupational, speech and physiotherapy as they grow and develop.

While the separation surgery took place on February 28, 2025, preparation began in the fall of 2024, soon after Sam brought her twins, Ally and El, to Seattle Children’s for an initial appointment.

“When I met with Dr. Smith and the other Seattle Children’s specialists for a surgery consultation, I knew my family would be in great hands,” recounted Sam. “Their expertise and approach to care really impressed my husband and me and made our decision to have the surgery at Seattle Children’s an easy one.”

“Conjoined twins are rare, and twins joined at the pelvis, as Ally and El were, are even a bit rarer”, said Dr. Caitlin A. Smith, co-director of the Reconstructive Pelvic Medicine program at Seattle Children’s. “The surgery required to separate them is highly specialized, but I was excited because I knew we had the right team in place. We think about surgery all the time, but this required another level of coordination and teamwork.”

To prepare for the highly complex, delicate surgery, starting in October of 2024 a specific care team of surgeons, anesthesiologists, and nursing staff was identified to take care of the twins on surgery day. This team included Seattle Children’s pediatric general surgeons, urologists, gynecologists, plastic surgeons, neurosurgeons, anesthesiologists, orthopedists, nurses and technicians. The team met monthly to talk through the flow of surgery in the operating room and plan for every detail. Everything from the placement of each piece of operating room equipment to the specific instruments needed and the potential back up equipment needed was decided during these meetings.

Before the surgery, detailed imaging was completed including MRI, fluoroscopy, and endoscopy to create a road map of their anatomy and what structures they shared. On the day of surgery, incisions were made carefully on each child’s shared abdomen and pelvis before deeper dissection was performed to separate their gastrointestinal, gynecologic, and urologic systems. They also required incisions between their pelvis to officially separate them.

To perform the reconstruction for each twin, the team placed absorbable mesh and complex soft tissue and skin coverage with flaps to complete the final stage of the surgery. The patients recovered in the Intensive Care Unit prior to being transferred to the ward.

“The relief that they were separated and safe was incredible,” said Smith. “Each twin got what they needed, thanks to our amazing, dedicated team who worked to ensure Ally and El’s health and safety were priority number one.”

While initially they had movement restrictions to help their wounds heal, Ally and El ultimately worked with rehab medicine physicians, physical therapists, occupational therapists and speech language specialists with our Seattle Children’s Inpatient Rehabilitation, prior to discharge. In late May of 2025, they were strong enough to leave rehab and continue recovery at home.

As they continue their sessions with Seattle Children’s therapists, Ally and El develop their speech, improve their fine motor skills and strengthen their muscles as they learn to walk.

“It’s incredible to watch our girls crawl quickly, learn new words and see their distinct personalities take shape,” said Sam. “We are very happy with the care we receive at Seattle Children’s. It was the right decision for our family.”

For more on conjoined twins diagnosis and care at Seattle Children’s, please visit: Conjoined Twins - Seattle Children's.