HEADS swathed in thick bandages, these are the first pictures of the two Siamese twins separated from each other in a marathon operation by surgeons in the United States.
Doctors said they were "absolutely positive" the one-year-old sisters from Guatemala - where they are affectionately known as "Las Maritas" or the Little Marias - will recover from the shock of the radical surgery, which took 22 hours to complete.
Maria Teresa Quiej Alvarez and Maria de Jesus Alvarez were today under sedation in critical but stable condition in the intensive care unit at the University of California, at Los Angeles Mattel Children’s Hospital.
One twin had to be taken back for a further five hours of surgery to stop bleeding on the brain. Both were expected to remain sedated for days.
But surgeons insisted the operation had been a success.
"I’m absolutely positive they will do OK. I’m absolutely positive if you go and visit them in five years they will be leading a normal life," said Dr Jorge Lazareff, the senior neurosurgeon.
He said doctors would have a clearer picture of the recovery time by Monday.
Dr John Frazee, another neurosurgeon, said it was not known whether they suffered any brain damage. "We just don’t know neurologically. They’re moving, which is a good sign.
"There’s no way of knowing what the state of affairs is for another week," Dr Frazee said.
After the risky separation surgery, Maria Teresa was wheeled back into the operating room for nearly five more hours because of a build-up of blood on her brain, Dr Lazareff said.
The surgery-related hematoma "was not necessarily an unexpected situation," said Dr Michael Karpf, medical director at the medical centre.
"This is very complicated surgery, and until we get past several days it will be life-threatening for both of them.
"We are minute-to-minute, hour-to-hour, day-by-day. We just can’t get ahead of ourselves."
The girls’ parents, Wenceslao Quiej Lopez and Alba Leticia Alvarez, kissed their girls before the surgery.
The twins were born attached at the top of the skull and faced opposite directions.
Conjoined twins occur once in every 200,000 live births, but twins who are fused at the tops of their heads, known as craniopagus twins, make up only about two per cent of those.
The girls face still more operations to reconstruct their skulls.
