<![CDATA[Abstract: Conjoined twins are a rare condition, occurring in approximately 1 per 50,000 to 100,000 live births. Long-term follow-up is essential to evaluate post-surgical outcomes, including organ function and surgical scar. We reported a case of thoraco-omphalopagus conjoined twins who underwent successful separation surgery in 2023. The most recent evaluation in August 2025 showed excellent developmental progress in both twins across motor, cognitive, and psychosocial domains. However, the second twin developed a keloid along the surgical scar. Liver function tests were normal in both twins, although alkaline phosphatase levels were elevated. Thoracic computed tomography revealed elongation of the xiphoid process in the second twin, while abdominal imaging demonstrated normal liver following resection of the fused liver. In conclusion, continuous long-term evaluation after separation surgery is vital to detect potential abnormalities at an early stage. Keywords: conjoined twins; separation surgery; thoraco-omphalopagus; long-term follow-up, postoperative outcome]]>
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