Introduction: Conjoined twins represent a rare congenital anomaly that poses significant challenges in management. Objective: This study aimed to assess the diagnostic, therapeutic, and evolutionary aspects of conjoined twins (CT). Methods: This was a retrospective and descriptive study conducted over 29 years (from January 1, 1995, toDecember 31, 2023). It included allcases of conjoined twins received in the pediatric surgery department of the National Hospital Amirou Boubacar Diallo in Niamey, Niger. Results: Eight cases of conjoined twins, involving 15 patients, were documented. The average number of prenatal consultations was 2.8, with only two cases diagnosed antenatally. The majority were omphalopagus twins and omphalo-ischiopagusparapagus twins (n=2). Of the seven cases operated on, 2 underwent surgery abroad, while 6 underwent surgical separation locally. The average age at separation was 49.5 days (range: 4 days to 5 months). The overall survival rate after separation was 7 out of 14. The overall mortality rate was 8 out of 15, including two preoperative deaths. Conclusion: The diagnostic and therapeutic management of conjoined twins over these years requires improvement. Despite surgical separation in almost all cases, the postoperative period was marked by frequent morbidity and mortality.