Siamese twins separated

For the first time ever the twins are in separate beds

Surgeons at a Los Angeles hospital have separated twin girls who were joined by the top of their heads.

But just five hours after the operation one of the twins, Maria Teresa was rushed back into surgery to treat a haematoma or bleeding on the brain, doctors said.

There was absolutely no major trouble that was unforeseen in this procedure

Dr Houman Hemmatti

A hospital spokesman said it was not an unexpected complication and that the outlook for both girls was still positive.

The other girl, Maria de Jesus remains in critical but stable condition.

The skulls of the one-year-old girls, originally from Guatemala, were fused with their faces tilted in opposite directions. They could hold hands, but not see each other face to face.

Emotional scenes

Speaking after the procedure Dr Houman Hemmatti told an American television network that the 20-hour operation was considered a success.

"Everyone has goose bumps at the end of the procedure," he told NBC. "People were cheering, people were clapping, people were crying."

Dr Hemmatti said the medical team was "more than optimistic" and added: "We can't wait until we see these kids playing, laughing, crying like normal baby children."

"There was absolutely no major trouble that was unforeseen in this procedure," he added.

Kissed goodbye

The girls, Maria de Jesus and Maria Teresa Quiej, came to Los Angeles with their parents two months ago after a non-profit group raised the money for their treatment in California.

Before the operation the girls were reportedly in good spirits.

The girls' operation has been paid for by a charity

"The girls were smiling a lot and were very playful," hospital spokeswoman Roxanne Moster said.

Their parents, Wenceslao Quiej-Lopez and Alba Leticia Quiej-Alvarez, kissed them goodbye before preparations for the operation got under way.

Doctors at the Mattel Children's Hospital at the University of California had already performed surgery on the twins to stretch their skin.

Doctors planted tiny expandable balloons under each baby's scalp so there would be enough skin tissue to cover their heads once they were separated.

High mortality

Although their brains functioned independently before the operation - lessening fears of their intellectual growth being stunted - some of their veins were joined.

Doctors had to preserve and re-route those veins or both twins risked suffering a fatal stroke.

The medical team rehearsed the operation using life-size models, which not only replicated the babies' blood vessels, but showed their veins.

"It's risky, but we feel pretty confident," said craniofacial surgeon Henry Kawamoto ahead of the operation.

Conjoined twins occur roughly once in every 200,000 live births.

Mortality rates are often high even if there is the possibility of separation, but doctors said the girls stood a better chance of survival if surgery was performed.