ORIGINAL ARTICLE Conjoined twins in the Philippines: experience of a single institution Esther Saguil Æ Josefina Almonte Æ Wilma Baltazar Æ Alfredo Acosta Æ Alvin Caballes Æ Antonio Catangui Æ Celine Villegas Published online: 21 August 2009 Ó Springer-Verlag 2009 Abstract Introduction We describe our experience with 22 con- joined twins managed from 1974 to 2006. Materials and Methods Records of 22 conjoined twins admitted from 1974 to 2006 were reviewed. Interviews with attending physicians were also conducted. Results There were 11 thoracopagus, 5 omphalopagus, 3 ischiopagus, 2 craniopagus, and 1 pygopagus twins. Five thoracopagus twins were deemed inseparable due to severe cardiac anomalies. One ischiopagus refused separation, and one craniopagus was separated elsewhere. Six twins (three omphalopagus, one each of pygopagus, ischiopagus, and thoracopagus) were separated emergently as neonates; only one twin is a long-term survivor. Mortalities were due to intractable acidosis, sepsis, and hemorrhage. Nine twins (one craniopagus, one ischiopagus, two omphalopagus, five thoracopagus) were electively separated between 9 months and 2 years of age. One set of these thoracopagus twins died of respiratory failure and sepsis post-operatively. A hydrocephalic twin in another thoracopagus twin died intraoperatively. The rest are alive and well. Conclusions Emergency separations yielded dismal results due to poor patient conditions; delay in separation allowed progressive deterioration and resultant poor outcome. Elective separation had more favorable results due to well-planned strategies, team preparedness, and better patient conditions. A multi-disciplinary approach, with parental participation, is integral in the holistic management of conjoined twins. Introduction Conjoined twins have always kindled immense interest in both the medical community and the general population, owing to their rarity and unusual presentations. The earliest successful separation of omphalopagus twins was per- formed in Switzerland by Johannes Fatio and reported by Koenig in 1689. The term Siamese twins was popularized when Eng and Chang, born in Siam in 1811, were exhibited in the United States by PT Barnum. The Philippines, a small Southeast Asian country of 85 million people, and a current birth rate of 2.34, has more than 30 years of experience in the surgical management of conjoined twins. We present the experience of the Philip- pine General Hospital, the largest state hospital in the country, where the majority of Filipino conjoined twins are brought for evaluation and definitive management. Materials and methods The case records and files of all conjoined twins admitted to the hospital from 1974 to 2006 were reviewed. Data regarding type of twinning, sex, shared organs, and man- agement, as well as outcome were determined. Interviews with attending physicians were also conducted. This study was approved by the Institutional Ethics Review Board. Results Twenty-two sets of conjoined twins were admitted to the PGH from 1974 to 2006. Twelve were female and ten were male. Only three (14%) were prenatally diagnosed. All E. Saguil (&) Á J. Almonte Á W. Baltazar Á A. Acosta Á A. Caballes Á A. Catangui Á C. Villegas Division of Pediatric Surgery, Department of Surgery, University of the Philippines-Philippine General Hospital (UP-PGH), Manila, Philippines e-mail: esther68ph@yahoo.com 123 Pediatr Surg Int (2009) 25:775–780 DOI 10.1007/s00383-009-2426-7