Tim and Shaneka Ruffin’s pregnancy changed dramatically when, during a routine ultrasound at 12 weeks, they discovered that their children were conjoined twins. The news brought a very difficult dilemma for the parents, since they were recommended to terminate the pregnancy. Shaneka recalled to Abc News that “when they said it was best to terminate the pregnancy, there were a lot of emotions.” However, the family decided to seek a second opinion at Children’s Hospital of Philadelphia (CHOP), where they were given new hope: even though their children shared vital organs, they could be successfully separated.
Amari and Javar were born on September 29, 2023 by cesarean section, weighing together around 2.7 kg. These omphalopagus twins were joined by the lower part of the sternum, the diaphragm, the abdominal wall and the liver. The complexity of his condition required careful planning for the separation operation. According to CHOP, multiple imaging studies, including ultrasounds, MRIs and fetal echocardiograms, were performed to study her anatomy and map out a plan that would ensure a safe birth.
The separation surgery was finally performed on August 21, 2024. A multidisciplinary team of more than two dozen specialists worked for eight hours to complete the operation. Dr. Holly L. Hedrick, pediatric general and fetal surgeon at CHOP, said, “Separating conjoined twins always presents challenges because each set of twins is different.” In this case, one of the most crucial aspects was the separation of the shared liver, for which intraoperative ultrasound was used to carefully identify and separate the blood vessels that connected it.
Recovery and rehabilitation process
After the complex separation surgery, Amari and Javar began a long recovery process at Children’s Hospital of Philadelphia (CHOP), which included physical therapy, occupational therapy, and speech therapy to help them reach developmental milestones like rolling over and crawling. The twins continued to work with specialists in the hospital’s Division of Physical Medicine and Rehabilitation to ensure their physical and motor development progressed appropriately. As Dr. Cassandra A. Ligh, a pediatric plastic surgeon, explained on the hospital blog: “Tissue expanders were placed before surgery to maximize the amount of skin and soft tissue available for separation.”
As they progressed in their recovery, the twins learned to move independently, something they would never have been able to do if they had remained attached. Their mother, Shaneka Ruffin, emotionally told People: “Seeing them each in their own bed was an indescribable feeling.”
return home
October 8, 2024 marked an important milestone for the Ruffin family. After almost a year in the hospital, Amari and Javar were able to return home for the first time. There, their older siblings, Kaylum and Anora, were eagerly waiting for them, who could finally live with their younger siblings outside of the hospital. As his mother explained: “It feels like we are starting a new journey as a family of six.” For the Ruffins, returning home was an emotional moment that marked the beginning of a new era in which they could make memories together outside of the medical environment.
Rare condition of conjoined twins
The case of Amari and Javar Ruffin is one of the few conjoined twins that have been successfully separated. This medical condition is extremely rare, occurring in approximately one in every 35,000 to 80,000 births. Omphalopagus conjoined twins, like the Ruffin brothers, represent a small percentage of this already rare condition. The hospital has performed a total of 32 separations of conjoined twins since 1957, the most of any center in North America. Dr. Holly L. Hedrick, who led the surgery team, explained, “The fact that these hearts were separated and fully functional was a huge victory,” since many conjoined twin cases do not make it to a separation operation because to the complexity of anatomical connections.
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