Surgeons successfully separated Allyson and Avery Clark today in a surgery that took almost seven hours — more than half of which was prep time spent draping, cleaning and arranging the girls.

Now the babies, who will turn 8 months old tomorrow, are for the first time resting in separate beds.

Avery was wheeled out of the operating room at 1:54 p.m., and Allyson followed 11 minutes later. They will spend the night in the intensive-care unit at Primary Children's Medical Center and will likely move to a regular room Wednesday.

The girls are the daughters of Kerry and Anna Clark. Kerry Clark is an F-16 crew chief at Hill Air Force Base, and the family, which includes three other girls under age 7, lives on the base.

Kerry Clark was smiling just moments after the operation was finished. "It couldn't be any better. There was no bad news at all," he said.

Asked how his daughters looked, he said it was "kind of strange" to see them separated.

Although they don't know if there will be complications or a procedure or two down the road for the infants, Kerry Clark said, "Everything that can happen from now on is stuff (PCMC doctors) do every day anyway. Simple stuff."

The girls were born joined at the base of their tailbones, and their spinal cords looped down like the letter U and connected. Lead surgeon Dr. John Kestle, a neurosurgeon, said when they opened the infants' dura, the fluid-filled sac that protects the spinal cord, they saw a space with nerves dangling on either side. They made the cut between those nerves.

"Things went well, we think," Kestle said. "We divided the tissue connecting the spinal cords. We are very happy with what we found. It looked like the connection was below the nerves."

The surgery was a matter of carefully cutting through the layers connecting the two girls, separating skin, fat, connective tissue and a "little tiny bit of bone." The surgeons separated the spinal cords last, cauterized them and then closed the dura. After the cut that separated the girls, Avery was moved to an adjacent operating table, where she was worked on by a separate team of surgeons.

Future complications could include bladder- and bowel-control problems, since the lower spinal cord helps control those functions. The girls could also have some ankle problems for the same reason. But after surgery, Kestle said the infants were kicking their feet, which is a good sign. As for the bladder and bowel, doctors may not know until the girls are potty-training.

There's also a slight possibility that scar tissue could form around the spinal cord and pin it down, which could also trigger those problems.

Dr. Faizi Siddiqi, a reconstructive and plastic surgeon, said that tissue expanders implanted about six weeks ago provided more than enough skin to cover the wounds, which were closed layer by layer with sutures afterwards. The extra skin was left in place, where it will likely shrink back to normal. If it doesn't, it may be removed surgically in six months or so, he said.

He left drains inside the girls temporarily, but closing the wounds was "pretty straightforward." They'll have a scar, but it will be "hopefully a fine line."

Kestle said the babies will be sore and likely quiet for a day or two, but when they feel up to it, they can start moving around. He expects they'll be hospitalized about a week.


Timeline:

7:40 a.m.: Operating Room

10:20 a.m.: First incision

11:26 a.m.: Physical separation

1:54 p.m.: Avery done and heads to pediatric intensive-care unit

2:05 p.m.: Allyson heads to the intensive-care unit

By 2:20 p.m.: Kestle declares the surgery a success


The team:

Team members included anesthesiologists Dr. Daniel Evans and Dr. Christopher Miller; neurosurgeons Dr. John Kestle and Dr. Douglas Brockmeyer; plastic and reconstructive surgeons Dr. Faizi Siddiqi and Dr. Courtney Crombie; orthopedic surgeon Dr. Alan Stotts and operating staff including registered nurses Diana Brown, David Giles and Sean Peters; surgical technicians Robin Thompson and Jennifer Pratt; and anesthesia monitor Jason Cox.


E-mail: lois@desnews.com