Formerly conjoined twins home for holidays

An early Christmas wish was granted to Andre and Angi Pitre of Apopka.

Their twin daughters, Jesi and Remi, were delivered on May 15 at UF Health Shands Children’s Hospital, conjoined at the abdomen. On July 23, they underwent successful separation surgery.

Remi was the first of the twins to be discharged, on Oct. 4. Jesi was discharged Dec. 3.

The family will be together for Christmas.

“The best Christmas presents ever,” Andre Pitre said, in a UF Health news release.

A team of hundreds of surgeons, specialists, nurses and technicians from UF Health cared for the twins during their six-month stay. There were challenges, starting with delivery. Up to 60 percent of conjoined twins are stillborn. For conjoined twins who undergo separation surgery, only 5 to 25 percent survive.

The Pitres chose to have the twins delivered and treated at UF Health Shands based on its track record. Since 2016, the teaching hospital has cared for four sets of conjoined twins.

“They knew we had experience and that we had successful outcomes,” UF Health CEO Ed Jimenez said.

In the case of Jesi and Remi, a multidisciplinary team cared for the twins in neonatal intensive care from delivery to the surgical date. The first step, which occurred weeks before the separation, was surgically installing skin expanders along the babies’ sides, from the armpit to the hip. UF Health plastic surgeon Dr. Jessica Ching installed the skin expanders and was later involved with reconstructing the abdomen of both babies following separation surgery.

Dr. Saleem Islam, chief of pediatric surgery at UF Health, led the team that performed the separation surgery. The babies shared a liver and were connected at the bottom of the intestines. After the intestine separation, Islam said the surgical team ran into an obstacle during the liver separation.

“It was really tough to figure out which part of the liver went to which baby because there was no real demarcation plane that we could go across and help to use to divide,” Islam said. “So we had to kind of make that up as we went and carefully use ultrasound to try to figure that point out.”

After five to six hours of surgery, both organ separations were successful. The recovery was slow, but steady. The twins dealt with wound infections and feeding issues. Jesi’s stay in the hospital was longer due to respiratory difficulties.

Through it all, the twins proved resilient.

“A case like this one reaffirms why we all work in medicine,” Jimenez said.

To deal with expenses related to the twins' care, the Pitres have created a fundraising page. Future surgeries will be needed to close their bellies with their own muscle and their own tissue. To bridge the gap, Islam said special pieces of mesh were used to cover organs so that skin could be put on top of them.

“It’s incredibly satisfying to see them go home as two healthy, very active and vocal babies with their own personalities, for sure,” Islam said. “Most of all, we’re thankful to God that we were able to do this. I think the entire team is incredibly thankful and incredibly happy.”