BACKGROUND/PURPOSE: Conjoined twins are some of the most challenging patients 
faced by surgeons. Pygopagus and ischiopagus twins present particular 
gastrointestinal and genitourinary reconstructive challenges. This study reviews 
the authors' experience with the perineal reconstruction of these types of 
conjoined twins.
METHODS: Retrospective analysis was performed for 3 sets of female conjoined 
twins undergoing separation between 1999 and 2001. Particular attention was 
given to the separation and reconstruction of the distal gastrointestinal and 
urogenital structures.
RESULTS: Three sets of female conjoined twins underwent successful separation 2 
pygopagus, one ischiopagus tripus) with 5 surviving infants. The sixth infant 
died of congenital anomalies incompatible with life. Four of the 5 surviving 
infants had diverting enterostomies. Two of these enterostomies have been 
closed. Perineal reconstruction consisted of anoplasty (5 of 5), vaginoplasty (4 
of 5), and urethroplasty (4 of 5). Although fecal and urinary continence are not 
completely measurable at this age (<3 years), all 5 survivors void 
spontaneously. Three infants with intestinal continuity have apparently normal 
defecation without the need of a bowel regimen.
CONCLUSIONS: With careful preoperative planning and a multidisciplinary team of 
pediatric surgeons and urologists, satisfactory reconstruction and functional 
outcome of the female perineum can be achieved in conjoined twins.