24-Hour Operation Separates Twins

Nine-month-old twins born fused from just below the rib cage to the pelvis and sharing a third leg were successfully separated by doctors Thursday morning in a 24-hour operation involving 50 doctors and nurses.

Doctors at Childrens Hospital Los Angeles said the girls are doing well, though the operation required removal of the sisters’ third nonfunctioning leg and use of the tissue to seal up their bellies.

“There’s no reason to think they will not survive or lead healthy lives,” said James E. Stein, the pediatric surgeon who led the procedure.

The hospital said the twins’ parents did not want to be identified and would only say the sisters are U.S. citizens.

One in every 200,000 births results in ischiopagus tripus twins -- one-legged infants joined at the pelvis and sharing a third leg, according to doctors at Children’s Hospital and Regional Medical Center in Seattle.

The twins had two livers, though doctors had to carefully detach the fused livers from each other. Each girl had her own heart, lungs, kidneys, bladderand small intestine, though the small intestines were attached. The girls shared one large intestine.

The identical twins were born in December along with a third sister, who was not conjoined. Doctors said they know of only one other case of conjoined twins being part of triplets.

Until the surgery, the twins faced each other at an angle, with their noses only inches apart, Stein said.

“They were always looking at each other. If one grabbed the rattle, the other grabbed the rattle and then they had a game of pull and tug,” he said.

The girls were only comfortable lying half-reclined, sitting on their third leg, with a U-shaped nursing pillow supporting their backs, Stein said. They could not crawl or roll over.

But, Stein said, despite their situation, “I found them happier than normal kids, or at least the ones that come to see me.”

Months before the operation, doctors had inserted silicone balloons in the girls’ torsos to expand the skin so they would have extra flesh when separated.

The surgery began at 6 a.m. Wednesday, with the operating room set to near-tropical temperatures to keep the sisters warm.

“Basically, we had to sort them out and reconstruct them,” Stein said.

Doctors pulled apart the small intestines, divided the livers and split the pelvis. Orthopedic surgeons then had to close the resulting C-shaped bone into rings for both girls. Surgeons folded tissue and skin from the third leg into each of the girl’s bellies and used parts of the bone to reinforce each of their pelvises.

Dr. Richard A. K. Reynolds, who led the Childrens Hospital orthopedic surgeons, said 9 months of age was a “perfect time” to attempt separation.

“Many of the musculoskeletal, developmental things occur between 6 months and 2 years of age,” Reynolds said. Performing the surgery now will “allow them to start developing normal musculoskeletal functions. Also, we like to do the operations when the bones are big enough ... but yet not too big or too stiff.”

Other doctors who have separated twins elsewhere said the operation has been attempted more frequently in the last 15 years. Until 1990, there were only 167 recorded attempts to separate conjoined twins.

Separations “have been feasible for quite some time, the difference now is that conjoined twins are being diagnosed prenatally and more babies are being delivered in hospitals where they can be kept alive,” said Dr. Bob Sawin, chief surgeon at the Seattle hospital and part of a team that separated a pair in 2000.

The sisters separated Thursday will remain sedated until today, and it’s unclear when they can leave the hospital.

Doctors emerged from the marathon surgery exhausted but upbeat about the girls’ future.

“I ran on adrenaline,” Stein said. “I only had to get coffee afterward.”

Times staff writer Steve Hymon contributed to this report.