9:22 a.m. Surgeons complete operation on Kendra and by 9:30 she'd been moved to the pediatric intensive care unit. Maliyah's already there.
The surgeries went "really, really well," according to coordinating surgeon Dr. Rebecka Meyers.
They were able to close the skin on both girls without having to leave any uncovered wounds or wound sponges, although they did employ synthetic dermis in place of some of Kendra's muscle.
The girls are both critically ill, however. Meyers describes them as swollen, in pain and with a lot of stress on their bodies, including the fact that the skin is "tighter" than they'd hoped it would be.
They will be heavily sedated for days to control their inevitable pain. And they will have help breathing because the doses required for pain management suppress respiration.
Meyers said the moment when the girls were separated and Kendra was carried to another operating room, 16 hours after the complex procedure began, was an emotional one. "I wept," she said simply.
"I've already told them I love them about a hundred times today," she said. "I'll tell them again."The girls will face more surgeries in the future and reconstruction is a long-term process.
8:20 a.m.: Parents Jake and Erin Herrin were just told that Maliyah is out of surgery and on her way to the pediatric intensive care unit, after more than 25 hours of surgery. A separate team of surgeons is still reconstructing Kendra's abdominal wall and closing her wounds. The medical team now predicts she'll be out of the operating room in a couple of more hours.
5:10 a.m.: Plastic surgeons are beginning to reconstruct Kendra's abdominal wall, while another team has been working on Maliyah for some time. It's the home stretch, but "kind of a lengthy one," said Dr. Catherine deVries, urologist.
3:45 a.m.: Doctors are closing Maliyah's abdomen, a time-consuming process done in layers. They now say Maliyah's operation is apt to end about 6 a.m. Kendra's will take longer because they have not yet started closing her skin over the wound.
1:30 a.m.: Reconstruction of Kendra's abdominal wall is "quite a bit more complex" than Maliyah's. The latter had more muscle and soft tissue. Because she will need a kidney transplant, much of her skin was expanded to make sure there was enough. The challenge became covering Kendra's wound. The surgeons used synthetic dermis to help, but her surgery was expected to run longer than Maliyah's.
The girls will be on ventilators for several days. Doctors want to support their breathing as long as they need the level of pain medication such as extensive operation requires.Both girls have now been given blood, not because of excessive bleeding, but due to normal oozing from wounds over the course of the long surgery.
12:30 a.m. (Tuesday, Aug. 8, 2006): "We'd just like to announce that we have two separate little girls," Jake Herrin tells reporters gathered outside Primary Children's Medical Center.
Kendra has been moved to a different operating room and surgeons say they probably have three or more hours of reconstruction left to perform. The girls shared a single pelvic ring, which was divided in half during the operation. Now surgeons must construct a full ring for each girl.
Doctors thought Maliyah might require dialysis during the operation, but so far she hasn't shown signs of needing it, and it's likely she won't for a couple of more days.Erin Herrin's already looking forward now to going home. "This is only a part of our lives," she said, adding she can't wait to be with all five of their children, together. At home.
10:50 p.m.: Kendra and Maliyah are no longer conjoined. Doctors finished separating them earlier than expected, and at 11 p.m. moved the girls into separate operating rooms to complete the surgeries, which will still take several hours.
10 p.m.: Doctors have begun to separate the liver, which will bring them very close to being able to separate the twins completely. At that point, it will become two operations. So far, Kendra has needed a small amount of blood. Doctors are still holding to a target time of 4 a.m. to complete the surgery, but it could run shorter or longer, depending on how smoothly the remaining stages go.
7 p.m.: The girls' condition remains very stable, but doctors say the bladders are more complex than anticipated. The doctors have now finished examining and deciding how to divide up bladder tissue. There are two bladders, but each girl contributes one-half the blood supply, nerves and urine to each one. They have decided now how to assign the tissue, but will not form the bladders until after the girls are separated. Then a separate team will work on each girl.
4:30 p.m.: Urologists are now working on the girls' urinary tracts and bladders.
1:30 p.m.: So far, no surprises, according to Dr. Rebecka Meyers, coordinating surgeon and chief of pediatric surgery at Primary Children's Medical Center and University Hospital. The girls are stable and seven hours into the surgery, they have not had to give the girls any blood.
Surgeons have successfully divided the large intestine. Now they're working on other organs in the pelvis. Typically, conjoined twins who are joined at the abdomen or pelvis share some organs, lack some and may have extra of others. But the Herrins have asked that very personal details about Kendra and Maliyah's anatomy be kept private.The surgery team is right on schedule and predicts the girls will be separated around midnight, at which time it will become two operations in adjacent rooms. They think they'll finish about 4 a.m.
10:45 a.m.: Doctors have been preparing the girls for more than three hours. They spent most of that time making sure Kendra and Maliyah were stabilized under anesthesia and positioning them so that surgeons will have access as needed to both girls' small bodies. A few minutes ago, the doctors made the first incision.The first stage of the operation will be a thorough examination of the pelvic area, which the girls share, to determine what needs to be done. The surgeons' plan is based on all the images from MRIs and CT scans, but they expect some surprises when they're actually inside. What they find will determine how much reconstruction they do during this operation. And that, in turn, determines how long the surgery will take.
8:45 a.m.: Doctors are still preparing the girls for the actual surgery. The draping process, including hooking up IVs and monitors, takes about two hours before the first incision.
7 a.m. (Monday, Aug. 7, 2006): The medical team takes conjoined twins Kendra and Maliyah Herrin, 4, to the operating room.It's a tearful parting, both girls a little apprehensive and emotional. Parents Jake and Erin and the twins cry a little.
The Deseret Morning News featured the twins in a special story. Click here to read the story.
Dr. Rebecka L. Meyers, coordinating surgeon; chief of pediatric surgery for both Primary Children's Medical Center and University Hospital and also an associate professor of surgery at the University of Utah School of Medicine.Dr. Michael E. Matlak, pediatric surgeon at PCMC, professor of surgery and of pediatrics at the U.
Dr. Daniel EvansDr. Simon Durcan
Dr. Faizi Siddiqi, craniofacial surgeon, PCMC, assistant professor of craniofacial surgery, U.Dr. Bradford Rockwell, chief, division of plastic surgery, U.
Dr. Patrick C. Cartwright, pediatric urologist, PCMC, chief, division of urology and professor of surgery at U.Dr. Catherine R. de Vries, pediatric urologist, PCMC, associate professor of surgery, U.
Dr. Alan K. Stotts, pediatric orthopedic surgeon, PCMC, assistant professor of orthopedic surgery, U.Dr. Peter M. Stevens, pediatric orthopedic surgeon, PCMC, professor of orthopedic surgery, U.
Radiologist:Dr. Keith White, pediatric radiologist, PCMC.
Operating room staff:Corinne Richter, registered nurse; Jeff Darcy, registered nurse, urology/eye team leader; Bob Padgett, registered nurse, general surgery team leader; Diana Brown, registered nurse, tissue manager; Jill Riley, operating room tech II; Alicia Zisumbo, operating room tech III, ortho co-team leader; Hillary Lamb, operating room tech III, general surgery co-team leader; Heather Anderson, operating room tech II; Malissa Hess, operating room tech II; Chelsey Gooch, core tech; Bonnie Broadwater, core tech; Robbie Johnson, monitoring tech; Celeste Turner, monitoring tech; Walter Durtschi, monitoring tech; Tom Andrus, pharmacist; Rae Ann Wilson, pharmacist and additional surgical unit staff.