Chloe and Nicole Astbury, the Siamese twins born last week, were on ventilators yesterday and may have to be fed on drips for up to a year after an 11-hour operation to separate their bowels.
The emergency, life-saving surgery also revealed future difficulties in dividing their liver, the only organ they share. Doctors refused to speculate on whether the twins can be separated within their first year, as was originally hoped.
Alan Dickson, the paediatric surgeon who carried out the operation at St Mary's hospital, Manchester, was still "cautiously optimistic" about the twins' future, but admitted the extent of the bowel damage was a "disappointment". The twins were heavily sedated but said to be doing "very well".
Tests and scans carried out within hours of Chloe and Nicole's birth on Thursday night alerted doctors to possible problems and by Saturday ultra-sound techniques had confirmed there was a potentially fatal obstruction in the upper part of their intestines. "It was an operation we always thought might be required" said Mr Dickson, who was helped with the surgery by Adrian Bianchi, the doctor who looked after Laura Davies, the multi- transplant child who died in 1993.
The problem happened because during pregnancy the twins' bowels had become tangled. Both children had lost a "significant amount" of the upper part of the bowel, but Mr Dickson said he was "satisfied" with their condition. "It was a complex procedure," he said.
The length of the small bowel, which is about 100cm long and capable of absorbing milk and nutrients, now holds the key to Chloe and Nicole's survival. A paediatrician, Dr Dorothy Garvie, said both their bowels should be at least 20cm long if they are to stand a good chance. "Less than that and their chances are small," she said.
The operation confirmed what the surgeons already believed - that the liver is the only shared organ. They still hope a separation involving a dividing of the liver can be carried out when the children are stronger. "We always believed that dividing the liver would be the major surgical difficulty and that remains the same," said Mr Dickson.
The separation would be a "surgical challenge", he said. "The liver join is very complicated. The whole join is very complicated." Doctors hadhoped to separate the twins, who are joined from the breastbone to the navel, between three and six months after birth. This now seems unlikely.
Their parents, Melanie, 25, and Brian, 26, an electrician, were said to be obviously concerned at the extent of the surgery but "bearing up well".
The family solicitor, Andrea McWatt, said: "The only way I can describe how they feel is to say relief. The hospital tonight say the girls are stable and as well as can be expected. They are both tough little ladies and have come through it all." (Graphic omitted)