Abstract This report describes separation of thoraco-omphalopagus conjoined twins and management of the hepatobiliary complications that ensued. The livers were fused and, although both infants had gallbladders, the extrahepatic biliary trees were fused. After separation, obstructive jaundice developed in one twin and she required a biliary diversion. The other twin had an external biliary fistula that only closed after resection of a segment of liver with no connection to the ipsilateral biliary tree. Closure of the abdominal wall defects with biodegradable patches proved very satisfactory and eliminated the problems with persistent wound sinuses related to nonabsorbable mesh.