Separated Twins Doing Well

For the first time in their young lives, Regina and Renata Salinas Fierros on Thursday lay in separate beds at Childrens Hospital Los Angeles.

Renata snoozed peacefully in the left bed, true to the order in which they had been conjoined. Regina, the smaller, feistier of the two, slept fitfully on the right.

The 10-month-old twins spent Wednesday in a marathon surgery, continuing into Thursday morning, that separated the bones, muscles and organs that had connected them from the chest to the pelvis, and then reconstructed their bodies. Though each had her own heart and lungs, they shared many organ systems and had been locked in a permanent hug.

Doctors said they expected the girls, listed Thursday afternoon in serious condition with good vital signs, to spend several weeks in the hospital. The twins should be able to walk eventually without help and lead normal lives, they added.

Doctors said it would have been difficult for Regina and Renata to develop normally, physically and psychologically, without the operation. Their conjoinment had already proved difficult; if one girl was awake, for example, she often would not let her sister sleep, the girls’ parents said.

On Thursday, speaking over the hiss and gurgle of machines connected to their daughters, Sonia Fierros, 23, and Federico Salinas, 36, said they were overjoyed by the successful separation.

“I can’t wait to hold one in this arm and one in the other,” Fierros said through a translator. Still, she said, adjusting to the change would take time.

“It’s weird because I was used to seeing them together,” she said. “I miss seeing them together.”

The operation began around 6 a.m. Wednesday. As the anesthesia took effect, the girls -- a tiny island of pink flesh in a sea of blue scrubs -- drifted off, arms draped over each other as surgeons prepared to separate them. Doctors made the first cut at 9 a.m. After splitting the twins’ fused breastbones and livers, they reconfigured their bowels, ureters and genitals.

They divided their fused pelvises soon afterward, and at 6:21 p.m., more than three hours ahead of schedule, doctors severed the last thread of muscle and tissue connecting Regina and Renata.

Regina, lying closer to the door, was taken to a separate operating room. In parallel surgeries, doctors then reconstructed the girls’ chests, organs, pelvises and body walls, which were closed with extra skin of theirs that had been prepared in advance. Regina was wheeled into the intensive care unit at 2:47 a.m. and Renata at 3:58 a.m.

“Seeing the girls today beginning to wake up and move and respond is really exciting for us all,” said James E. Stein, the pediatric surgeon who led the operation.

The girls will be closely observed for bleeding and signs of infection in the critical 24 to 48 hours after the surgery. In the long term, doctors said they will need at least three years of physical therapy and, potentially, future operations.

In addition to the scarring both will have, Stein said Regina will probably have to defecate for the rest of her life through a hole in her stomach and into an attached bag. Doctors connected the end of her small intestine to her skin because she lacks an anus and normal muscle there.

Regina and Renata were born Aug. 2 at Los Angeles County-USC Medical Center. Their parents, who are from Juarez, Mexico, discovered the girls were conjoined when they were visiting relatives in Los Angeles and the then-pregnant Fierros was hospitalized with a urinary tract infection.

Thinking their babies would receive better medical care in the U.S., the couple decided to stay on extended tourist visas.

Because the twins are U.S. citizens, they are covered under Medi-Cal, the federal and state insurance program for the poor, and California Children’s Services, a state program that pays for treatment in certain unusual cases.

Childrens Hospital declined to disclose the tab, saying hospital policy prevented it from doing so.

Salinas said his daughters’ conditions and immigration issues would dictate whether his family returns to Mexico, which he said he would prefer to do.

In the meantime, he said, he and his wife would care for their twin daughters and wait “to see them walk, live normal lives like other children, go to school ... “

“Dance and sing,” Fierros finished.