Chilean doctors successfully separated conjoined twin girls in a marathon 20-hour surgery, saying Wednesday that the operation went extremely well despite challenges.
The 10-month-old twins Maria Paz and Maria Jose were recovering in an intensive care unit, and doctors said the next two days would be critical as they watch for infections or other possible complications.
Parents Jessica Navarrete and Roberto Paredes kept an anxious vigil at Luis Calvo Mackenna Hospital in Santiago as doctors separated the twins at the thorax, abdomen and pelvis. It was the seventh and most complex operation yet for the twins.
Doctors successfully separated the twins late Tuesday night. Chief surgeon Francisco Ossandon described it as the moment "the girls finished the process of being born."
"Before, they had two souls and one body," Ossandon said.
Surgery on one of the twins was completed early Wednesday after a total of 19 hours, while for the other it took more than 20 hours.
"We had a number of difficulties during the surgery. There were some surprises, but we were able to fix, solve the problems," Ossandon said at a news conference.
He added that the twins came out of the surgery in good condition. Ossandon, however, didn't rule out future complications involving the effects from anesthesia and possible infections.
"We're very happy because we think they've had the best evolution we could have hoped for," he said.
The girls' parents appeared in televised images as they kissed the twins before the operation. Then afterward, the mother and father gazed lovingly at the sleeping girls from beside their separate cribs in the intensive care unit.
Paredes softly placed a hand on one daughter's head.
Some Chilean television stations occasionally broke into their regular programming to broadcast updates from the doctors, both during and after the delicate surgery.
"The next 48 hours will be the most critical in terms of the ... risk they face of dying," said Dr. Carlos Acuna, chief of the intensive care unit. He said the girls faced risks of various organs ceasing to function, and also had kidney and lung problems.
The girls' mother said she was hoping for a miracle when the high-risk operation began Tuesday morning.
The Chilean twins presented a particularly difficult challenge because they were born sharing many of the same internal organs and even urinary system. About 100 people participated in the procedure, including 25 surgeons and anesthesiologists.
Perhaps providing some comfort to the parents was the hospital's history with conjoined twins. Staff there have separated three sets before. A fourth set, however, died during surgery due to cardiac complications.
According to the University of Maryland Medical Center, roughly one out of every 200,000 live births worldwide results in conjoined twins. The overall survival rate is between 5 percent to 25 percent, depending on various factors, including where they are joined.
While rare, such surgeries have become increasingly frequent over the years due to improvements in surgery, anesthesia and critical care, said Dr. Eric Strauch, a surgeon at the University of Maryland Medical Center.
"We've gotten better at dealing with them," Strauch said. "I think people are willing to undertake it more."
He said he has performed surgeries on two sets of twins. The first set, girls from Uganda, survived in 2002 and are now about 10 years old, he said.
"The second set survived for about six months after the separation, but they both succumbed to infection," said Strauch, adding that their intestines were unable to function.
He said he knew of another successful case in which two girls were separated and have reached adulthood.
"They're in their 20s and they're just graduated from college," Strauch said. "A lot of them don't do well, but a lot of them do."
Dr. Steven Fishman, a pediatric surgeon at Children's Hospital Boston, said that if twins make it out of the hospital without post-surgery complications, most tend to survive.
"If they're felt to be well enough to go home, in general they will make it long term," he said.
The Chilean twins were born in the Villarrica hospital about 470 miles (760 kilometers) south of Santiago and were kept under constant medical care, surviving with the aid of an artificial respirator.
Earlier this year, doctors separated the twins' legs, urinary tracts, pulmonary systems and other parts of their bodies. They now each have part of a leg that used to be fused together.
During the latest surgery, doctors managed to separate an intestine that had been shared by the two, giving each of them part of it, said Jaime Manalich, the government's health minister, who visited the family at the hospital.
Surgeons weren't able to completely close their abdominal cavities or their thoraxes, and therefore had to use meshing to cover them, Ossandon said. "These are foreign bodies that sometimes the body recognizes as foreign, and that can cause infections," he said.
Maria Jose was the first twin to reach the intensive care unit after the surgery. Her sister Maria Paz, whose operation was more complex due to difficulties in the area near her heart, arrived an hour and 15 minutes later.
They were born in February, and since then have been hospitalized and attached to machines including an artificial respirator.
The girls were still connected to a respirator on Wednesday.
They are to remain sedated for at least three days.
Ossandon said the twins will return to the operating room every two or three days so that doctors can clean their wounds. He called the surgery their "rebirth."
Associated Press writer Ian James in Caracas, Venezuela, contributed to this report.