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From The Human Centipede wiki article:

The Human Centipede (First Sequence) is a 2009 horror film starring Ashley C. Williams, Ashlynn Yennie, Akihiro Kitamura and Dieter Laser, directed by Tom Six.^[1] It tells the story of a crazed doctor who surgically joins three victims together, mouth to anus, to create a “human centipede“. The film has won several awards at international horror film festivals, but has received mixed reviews from critics.

The doctor explains that he is a world renowned expert at separating conjoined twins, but dreams of creating new beings that share a single digestive system by joining separate individuals via their mouths and anuses. He explains that his previous experiment, a “3-dog”, died. However, he explains how he will attach the three human subjects to each other to create a “human centipede”. Once the operation is complete, the doctor begins training the centipede to perform tasks. Katsuro, as the front part of the centipede, refuses to do as he is told, and the doctor beats him. When Katsuro has to defecate, Lindsay is forced to swallow his excrement and the doctor watches with great delight. However, Heiter eventually becomes irritated after being kept awake by the centipede’s constant screaming and realising that Jenny is dying from blood poisoning.

Directing

When seeking funding for the film, Tom Six did not initially let on that the victims of The Human Centipede would be joined by mouth to anus, fearing that it would put off potential investors, and his backers did not find out the exact details of the film until it had been completed.^[8] Additionally, the actors themselves were not presented with a completed script prior to signing onto the film, instead only being given an outline of the film’s storyboard.^[13]

Effects

Throughout the production process Tom Six stated his intention to create a film that was “100% medically accurate”,^[13] consulting a real-life surgeon during the creation and filming process.^[14] Six has claimed that whilst initially reluctant to take part in the film because of professional reputation, after reading the script the surgeon consulted took a very strong interest in the procedure, devising a method that he believed would work in real life. Six claims that by using an IV drip to supplement the diet of the middle and back parts, the centipede would be able to survive for “years”.^[7][15]