USC Doctors Will Attempt to Separate Conjoined Twins

For the first 10 months of their lives, Regina and Renata Salinas Fierros have been facing each other in what looks like a permanent hug.

Today, a team of 80 doctors and nurses will attempt to separate the twin sisters, joined from the lower chest to the pelvis, in an operation that could last 24 hours or more.

The conjoined twins, whose breastbones, livers, intestines and pelvises are fused, will undergo what doctors at Childrens Hospital Los Angeles described as a relatively rare and complex surgery.

As ischiopagus tetrapus twins, Regina and Renata each have two legs but share many organ systems, said Dr. James E. Stein, the pediatric surgeon leading the operation.

About one in every 2.5 million births results in this type of conjoined twins, Stein said. Childrens Hospital has separated five pairs of conjoined twins in the last 40 years. In three cases, both twins survived.

Surgeons will divide the Salinas Fierros twins during the first part of the operation, deciding along the way, for example, whether to give the shared large intestine to one twin or divide it between the two. A person can survive without a large intestine.

The doctors then will reconstruct the girls’ chests, organs, pelvises and body walls.

“It’s exciting and it’s stressful, but we’re really looking forward to giving the kids a new life, a new opportunity to really be themselves and be able to function in a normal way down the road,” Stein said.

He added that though complications are possible, he expected the twins to make it through surgery successfully.

The cost of the operation will be covered by Medi-Cal, the state health program for the poor, and California Children’s Services, a state program that treats children with certain physical limitations and chronic health conditions. Childrens Hospital spokesman Steve Rutledge would not disclose the cost.

Regina and Renata were born Aug. 2 at Los Angeles County-USC Medical Center to Sonia Fierros, 23, and Federico Salinas, 36, both natives of Juarez, Mexico. The couple found out that the girls were conjoined last spring, when they were in Los Angeles visiting relatives and the then-pregnant Fierros was hospitalized with a urinary tract infection.

Thinking the twins would receive better medical care in the U.S., they decided to stay in Los Angeles on extended tourist visas.

“We were expecting a 15-day trip,” Fierros said Monday through a translator. “We were coming to a family celebration.”

“When we found out, everything changed,” Salinas said.

The couple has since been living in San Fernando with the twins, who receive regular care at Childrens Hospital, and their two other young children.

At home, when one twin sleeps, the other often does as well -- though a wide-awake girl might not let her sister sleep, Salinas noted. When one feeds, the other often helps lift the bottle.

Their makeshift stroller is a red Radio Flyer padded with pillows.

The twins have undergone several surgeries in advance, including having silicone balloons inserted under their skin and expanded to create extra tissue for surgeons to work with during reconstruction.

Regina, the smiley twin on the right side, has more respiratory congestion and a more severely curved spine. She has one kidney while Renata has two, and is smaller than her sister.

For some unknown reason, the conjoined twin on the right is always physically weaker, Stein said.

The girls’ parents said Monday that they were confident the surgery would turn out well but could not help feeling anxious.

The surgery could determine whether they ever run or live independently, Fierros said.

Doctors said the timing is ideal. At 10 months, the girls’ tissues and bones are small and pliable enough for easy manipulation. In addition, their sense of self is still developing. Twins who have been joined for more than a year can have a difficult time separating emotionally and psychologically.

The separation of the twins’ livers and pelvises poses particular risks, but doctors will be on the lookout for possible complications, said Dr. William B. McIlvaine Jr., who will be leading the anesthesiology team.

The team is intimately familiar with the girls’ physiology because of the previous procedures they have had at Childrens, he added.

The 80-member operating team, whose members will come and go in shifts, is expected to be fully present to finish working on the twins once they are separated.

“We just hope that it’s a success, that they have a normal life like every other child,” Salinas said. “We’re going to pray to God and wait for the moment the doctors tell us everything went well.”