- Associated Press - Tuesday, November 1, 2011

PALO ALTO, CALIF. (AP) - Surgery began Tuesday morning in Northern California to separate twin girls joined at the chest and abdomen.

The complex procedure to separate Angelina and Angelica Sabuco, of San Jose, got under way at Stanford University's Lucile Packard Children's Hospital around 6:30 a.m. Tuesday.

If all goes according to plan, the 2-year-olds will be out of surgery by mid-afternoon, said hospital spokeswoman Reena Mukamal.

The operation will involve cutting along the girls’ skin and muscle and separating their diaphragms and livers. Severing the liver will be the riskiest part of the procedure because of potential blood loss, said Dr. Gary Hartman, the lead surgeon.

Hartman, who has done five separation procedures at medical centers around the country, said he expects the operation to go well.

Keeping the girls joined carries bigger risks for their health, doctors said. If one conjoined twin dies, the other will die within hours. Muscular and skeletal deformities can also worsen with time.

“We want them to live normally,” said Ginady Sabuco, the girls’ mother. “When they argue, they can be alone. When they play, they can play together or apart. When they don’t want to see each other, they won’t have to.”

Angelica and Angelina are classified as thoraco-omphalopagus _ joined at the chest and abdomen. Their livers, diaphragms, breastbones, chest and abdominal wall muscles are fused. They have separate hearts, brains, kidneys, stomachs and intestines.

The children will not likely need intense physical therapy following surgery but may experience regression with some milestones they’ve already hit, Hartman said. The girls can walk now despite their face-to-face orientation but may lose that ability, for example, for a few weeks to months while they recover. They were expected to be in the hospital for two to three weeks.

Angelina and Angelica were born in the Philippines. They live in San Jose with their parents and 10-year-old brother.

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