LONDON -- Surgeons separated conjoined twins in a 20-hour operation that led to the death of one of the 3-month-old girls but was the only way to save her stronger sister, doctors said Tuesday.
St. Mary's Hospital in Manchester said the stronger twin, known only as Jodie, was in critical but stable condition after the surgery ended at 5 a.m. Tuesday.
"Unfortunately despite all of the efforts of the medical team Mary sadly died," the hospital said in a statement. "As with all major surgery, the first few days following an operation are the most critical and our thoughts remain with Jodie and her parents."
The hospital provided no details of the complicated procedure, which followed months of legal dispute over whether the parents could refuse surgery and let nature take its course.
Jodie and Mary were born at St. Mary's Hospital on Aug. 8, joined at the lower abdomen and doctors said if they were not separated, both would die within months.
Doctors said surgery could allow Jodie to have a normal life, but Mary's heart and lungs were nonfunctional and she would not survive once she was separated from Jodie's aorta.
The twins' parents -- identified only as Roman Catholics from the Maltese island of Gozo in the Mediterranean -- opposed the operation for religious reasons but decided not to contest a Sept. 22 decision by the Court of Appeal that the girls can be separated.
The court had struggled with the issue of whether the surgery would amount to intentionally killing Mary. Two medical specialists appointed by the court endorsed surgery.
"The sad fact is that Mary lives on borrowed time, all of it borrowed from her sister," Lord Justice Alan Ward said in the Court of Appeal ruling. "She is incapable of independent existence. She is designated for death."
The official solicitor's office, which represents children's interests in court, had provided legal representation for both children.
On Friday, judges rejected a last-minute appeal by the Pro-Life Alliance, an anti-abortion group that wanted the case to be decided in the House of Lords.
According to testimony at the Court of Appeal, surgeons expected to begin the operation by exploring the twins' anatomy. The separation process was expected to start with the pelvic bones and then go to the spines, where the twins were joined.
"Finally and eventually we have a major blood vessel, which is the continuation of Jodie's aorta, which is bringing blood across to Mary, and similarly the vena cava, which is returning blood from Mary to Jodie.
Those would need separating, dividing. It is at that point that we would expect that Mary would then die," the court's judgment said, quoting a surgeon who was not identified.
Doctors say Jodie will probably need further surgery to reconstruct some organs damaged in the surgery, including her rectum, sexual organs and lower abdomen. She is also expected to need skin grafts.
Prof. Lewis Spitz, consultant pediatric surgeon at London's Great Ormond Street Hospital, who has separated conjoined twins, said the next 48 hours will be crucial for Jodie.
"These babies are extremely critical after surgery and they have to be carefully monitored in intensive care," he said. "They are very unstable, requiring meticulous attention to fluid replacement and other monitoring. You have to remember that a huge body mass has been taken from them of between at least 45 to 50 percent."
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