Conjoined twins separated in marathon operation

Surgeons in Salt Lake City successfully separated conjoined twins on Tuesday morning in a 25-hour operation. Four-year-old Maliyah and Kendra Herrin had been joined at the abdomen, had one set of legs and shared a kidney.

“Our little Maliyah is all done!” said a posting on the Herrin family’s website at 8.20am on Tuesday. “We are so proud of her.
We can’t believe how strong she is. This is an absolute miracle!”

Within an hour the reconstructive surgery on her sister’s abdominal wall was completed and they were both moved out of the operating theatre to sleep for the first time in separate beds.

Surgeons planned to give each girl one leg and Kendra the kidney. Maliyah will receive dialysis for three months until she is strong enough to receive a kidney transplant from her mother. Each twin will also be fitted with a prosthetic leg. Surgeons also separated the twins’ shared liver and their intestines. Both girls had accessed the single kidney through the shared liver, to which both supplied blood.

Surgeons said they had not come across another separation that involved a single kidney. And the different procedures are rarely carried out on conjoined twins and seldom in one operation.

“What’s unusual is doing them all in one single surgery, in two separate girls, followed by the physical separation of the children,” hospital spokesperson Bonnie Midget told reporters.

But the hospital’s chief of paediatric surgery, Rebecka Meyers, said the days ahead would still be tough.

“We have big concerns with both girls,” she said. “Maliyah’s big concern is her kidney function and her dialysis. And Kendra’s big concern is going to be the coverage of her abdomen.”

Though conjoined twins are normally separated at a much younger age, surgeons had to wait until Maliyah was strong enough for a kidney transplant. The family said the girls had told them they wanted to lead separate lives.

“We are very thankful to have been able to have been the parents of Kendra and Maliyah these last four years because they touch people in a way that no two people or one person can touch anybody,” the twins’ father, Jake Herrin, said outside the Primary Children’s Medical Centre. “They are just so energetic, so lively and they inspire and we all can learn a lot from them.”

Preparations for the surgery started in June, when surgeons implanted 17 balloons to stretch skin and muscles to create enough tissue to cover their abdomens after the separation.

The procedure began at 7.15am on Monday, and by 10.50pm that night the separation was completed. Shortly after, one of the twins was moved to another operating room to begin reconstructive surgery, which lasted a further nine hours. The twins were lifted every hour to make sure their stretched skin was withstanding the operation.

Despite spending weeks examining MRI and CRT scans of the twins to determine which girl supplied blood to which organs, the six surgeons were prepared for surprises. But on Tuesday they said everything had gone according to plan. “They are telling me that they expect everything to look as they expect it to look,” Midget told reporters.

The family, including the girls’ six-year-old sister and year-old twin brothers, thanked the surgeons on their website. “Everyone is still in great spirits, although a little delirious at this point!” a posting said. “We could not be more pleased with the outcome. The surgeons and support staff have been absolutely amazing.”

Conjoined twins occur about once in every 50 000 to 100 000 births. Only about 20% survive to become viable candidates for separation. At least a dozen twins joined at the abdomen have been successfully separated in the past 20 years.—Guardian Unlimited Â

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