We are reporting anesthetic management of a case of successful separation of pygopagus twins. Conjoined twins are the result of an abnormality in fission of the primitive streak occurring during the first two weeks of development, and they are always of the same sex. These absormalities usually have multiple common organa, and surgical separation with survival is extremely rare. We are reporting our experience concerning the anesthetic management of this case along with the precautions and give some references.