The present study aims to report our experience in conjoined twin separation surgery in Assuit university and pediatric hospital, Assiut university, Assiut, Egypt over a period of 20 years.

A conjoined twin is a subset of monozygotic twin gestation. It's a rare phenomenon with an incidence of 1 in 50,000 to 1:100,000 births with the higher incidence in Africa and Southwest Asia. Based on the terminology proposed by Spencer and colleagues, conjoined twins are classified according to the most prominent site of conjunction into three major groups; First, twins with a ventral union; [cephalopagus (head), thoracopagus (Thorax), omphalopagus (Abdomen) and ischiopagus (pelvis)]. Second; twins with a dorsal union; [pygopagus (sacrum), rachipagus (spine, back) and craniopagus (cranium)] and lastly; twins with a lateral union that is referred to as parapagus (side). Depending on the aspect of the embryonic disc, the most common types are thoracopagus (19%).

Surgical separation of conjoined twins is extremely challenging taking in consideration the high perioperative risk. The low incidence of such surgeries and anatomical variations in each type of conjoined twins makes each separation surgery a unique experience.

Inclusion Criteria:

• conjoined twins
• symmetrical or
• asymmetrical.

Exclusion Criteria:

• conjoined twins incompatible with life
• conjoined twins with decapitating medical illness.

conjoined twins whether symmetrical or asymmetrical.