Doctors in Utah completed reconstructive surgery on one of two formerly conjoined twins yesterday after a 16-hour operation separated the girls born fused at the midsection.
Four-year-old Maliyah Herrin was recovering in a paediatric intensive care unit while plastic surgeons continued to build an abdominal wall for her sister, Kendra.
The twins had shared a liver, a kidney, a pelvis, one set of legs and part of their intestines.
Surgeons at Primary Children's Medical Centre in Salt Lake City gave each girl one leg, split their liver and intestines and reconstructed their bladders and their pelvic rings.
Kendra kept their one functioning kidney, while Maliyah was prepped for kidney dialysis and a transplant in three to six months.
The Herrins' separation is believed to be the first performed on conjoined twins with a shared kidney, said the hospital's chief of paediatric surgery, Dr Rebecka Meyers.
Meyers said the surgery, while complicated, had not presented any major surprises for the team of six surgeons, two anaesthetists, two urologists, one radiologist and more than 25 nurses and medical technicians.
"We have big concerns with both girls," said Meyers. "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."
Surgeons said Kendra has less muscle and tissue for use in closing her abdomen. They planned to use synthetic skin.
Dr Meyers said Maliyah did not require immediate placement on dialysis, but she expected that may happen within a few days. When the girl is strong enough, she will get a kidney from her mother, Erin Herrin.
"For kidney transplant, my time frame is really dictated more by Maliyah than by me, because there are just benchmarks she has to meet," Dr Meyers said.
The twins are expected to remain in intensive care for about a week and recover in the hospital for at least a month.
Conjoined twins occur about once in every 50,000 to 100,000 births. Only about 20 per cent survive to become viable candidates for separation.
In most instances, conjoined twins undergo separation surgery between ages of six and 12 months.