Background: Conjoined twins (CTs) are rare and Anesthesia may be required for diagnostic imaging, invasive procedures and/or separation. This article described the anesthetics for CTs’ separation performed locally in West Africa from 2016 to 2022. Anesthetic management for the separation of conjoined twins performed from 2016 to 2022 in five West Africa countries, Benin, Burkina Faso, Guinea, Niger and Senegal, are reported on. Methods: Anesthetic management for the separation of conjoined twins performed from 2016 to 2022 in five West Africa countries, Benin, Burkina Faso, Guinea, Niger and Senegal, are reported on. The data collection was done retrospectively. Each country was sent their data to Burkina Faso for study. The parental consents were obtained for surgery and publication. Results: During the period, nine conjoined were reported. The cases were: 5 omphalopagus, 2 pygopagus, 1 xipho-omphalopagus and 1 thoraco-omphalopagus. Inhalation anesthesia or propofol combined with IV opioids were used. Monitoring relied heavily on pulse-oximetry. Manual ventilation was used in five separations. Separations were achieved in 1.5-4 hours. The death of a twin triggered surgery in one pair and three other babies died after the surgery. The fourteen remaining babies developed well. Peri-operative difficulties revealed widespread difficulties in Africa. Conclusion: CT separation surgery still constitutes an extraordinary challenge in low and middle income countries, but well-trained anesthesiologists, a multidisciplinary approach and international contacts can lead to safe performance of complex neonatal surgeries.