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In my fictional dictatorship, a high-profile prisoner needs to be observed at all costs lest he harms himself or attempts to flee. Thus, the Ministry of State Security has devised a method of making sure that a policeman always stays with him: by permanently biologically binding the two people.

Is it possible to surgically interconnect the intestines of persons A and B so that food digested by person A passes to be excreted by person B and vice versa? If yes, is it possible to graft skin around the connection so that it can heal naturally? What complications can arise and how can they be prevented? And last but not least: if one person dies, what happens to the other person?

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    $\begingroup$ This is that human centipede thing. And you know it. $\endgroup$ – Willk Oct 8 '19 at 19:54
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    $\begingroup$ No. It’s not ass to mouth connection. It’s opening both people’s stomachs, cutting the intensines at the same place, crossing them over and sewing them together. $\endgroup$ – MedwedianPresident Oct 8 '19 at 19:57
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    $\begingroup$ "lest he harms himself." All he has to do after this surgery is spin 360 and tear his own intestines open. $\endgroup$ – lazer-guided-lazerbeam Oct 8 '19 at 21:34
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    $\begingroup$ Isn't that just as much torture to the policeman? Who would want to do have that as their job, inescapable intimacy, 24/7, potentially life ending, face-to-face with a criminal one probably hates, listening to their crap, unavoidably ripping each other apart after some time. Even lovers would hate to be forced to live as conjoined twins. If anyone would do this willingly they'd have a serious mental illness. $\endgroup$ – Backup Plan Oct 9 '19 at 8:24
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Thus, the Ministry of State Security has devised a method of making sure that a policeman always stays with him: by permanently biologically binding the two people.

The minister for state security needs to start firing his staff. Unless it was his idea, in which case he needs firing. The police officer involved should probably also have a word with their union representative.

Seriously, this is like the worst possible way of doing this. You need to keep the prisoner safe and under observation? Then why are you subjecting them to horrifically dangerous surgery with inevitable life-threatening complications? As Willk observed, this isn't about practicality, is it?

edit: the unfortunate police officer involved will still have to sleep. Therefore they cannot keep the subject under observation at all times, nor prevent harm arising. So not only is this silly and dangerous, it also doesn't allow for shift work. In case you were wondering, the solution is not to add a second police officer to the ensemble.

Is it possible to surgically interconnect the intestines of persons A and B so that food digested by person A passes to be excreted by person B and vice versa?

Yep. Simple matter of plumbing. Just an unnecessarily complex and unpleasant extension of the stoma concept.

If yes, is it possible to graft skin around the connection so that it can heal naturally?

What complications can arise and how can they be prevented?

Well, this has suddenly become quite a different sort of problem, hasn't it? Now, instead of just merely sharing poop, you're trying to have live tissue from two different people all squidged together. Now you need to make sure that they have the same blood type, and then you need to dose the two of them with immunosuppressive drugs to prevent their immune systems attacking each other (see transplant rejection and graft-vs-host disease for what can go wrong there).

The joint point will probably develop a lot of scar tissue, as it will be difficult to completely and cleanly immobilize, and is a serious weak point for infections to enter the body. Oh, and by futzing around with the sealing of the two party's intestines, you've added a new way for bacteria to leak into their bodies. They'll probably have to receive chronic antibiotic therapy to prevent life-threatening sepsis. Better hope neither of them was carrying traces of anything antibiotic-resistant, just waiting for a chance to break free (see clostridium difficile for an example of such an opportunistic pathogen).

edit: the ensemble clearly won't be able to walk around under their own steam, because this will put additional strain on the join which is already a very weak and vulnerable point, and probably where the infection will start that ends up killing them both. They'll need a specially adapted wheelchair for two. This means that they'll probably both suffer from muscle atrophy of their lower bodies. They'll also risk developing pressure ulcers, given the inconvenience of safely repositioning the two people such that they don't put continual pressure on one area of their bodies. The ulcers will also be an excellent source of lifethreatening infections, and will cause ongoing discomfort.

if one person dies, what happens to the other person?

It depends on what they died of. Under the circumstances, probably sepsis, which means that the other half of the party will be joining them very shortly.

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    $\begingroup$ There's also (though partially addressed in this excellent answer) the issue of where exactly this conjoinedness would be implemented. For simplicity, it'd probably be stomach-to-stomach, but that rather radically reduces the mobility of both individuals. $\endgroup$ – jdunlop Oct 8 '19 at 20:52
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    $\begingroup$ @jdunlop honestly, grafing people together via any part you coudl feed intestines through is likely to radically reduce their mobility. If nothing else, you probably don't want them to be able to walk, cos they might tear if one trips over... $\endgroup$ – Starfish Prime Oct 8 '19 at 21:01
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    $\begingroup$ winces There's a mental image that won't leave for a while. $\endgroup$ – jdunlop Oct 8 '19 at 21:39
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    $\begingroup$ Wish I could give an extra upvote for the intro. $\endgroup$ – Renan Oct 9 '19 at 0:03
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    $\begingroup$ I'm surprised you haven't mentioned mental scarring and PTSD for the two victims / patients in the complications section... $\endgroup$ – Whitehot Oct 9 '19 at 10:08
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Reality Check =

PASS

Welcome to the wonderful world of colorectal surgery!

The underlying procedure in this bizarre world of stercofocused dictators is the ordinary end to end anastamosis. Any kind of plumbing inside the body can be snipped and put back together. Such procedures are regularly performed after removing a stenosis or blockage for example. Anywhere a tube isn't functioning properly.

Step 1.
In today's exciting chapter of MOSS-bioforce, officer Juarez and prisoner Jenkins are going to be buddied up for life in a three part surgical extravaganza! First, the reconstruction team will create permanent bony or cartilagenous windows in the abdominal wall of the two victims, I mean patients! This window will be built up of a structural support component, a muscular component and a fatty & connective tissue component. The window must be kept patent, because officer Juarez is not going to be happy with suffering chronic bowel obstruction from prisoner Jenkins's incessant clamping down of his abdominal muscles. The muscular component of the window is required to bond the two window frames together into one flexible but strong component. The fatty & connective components will provide a layer of cushiony protection. Over all of this, the reconstructive team will use skin tissue that has already been stretched with tissue expanding implants in order to form skin flaps over and around the window.

Step 2.
The critical part of this sadistic plan is the simple bowel anastamosis. Each person's belly will be opened, the large intestine (descending colon) will be identified, transected and temporarily closed to prevent poo spillage. A long segment will separated from its native mesentery and fed through the bony window already prepared.

Anastamosis video, now with peppier, happier music!

Next comes the "exciting" part! In order to reanastamose the now criss-crossed intestines, huge long staplers will be shoved up each patient's (I mean victim!) butt, pushed through to the other fellow's intestine and permanently stapled togther, the temporary closure having been removed.

Miconvey Technologies Disposable End-to-end Anastomosis Circular Stapler

Here, the native rectum is in place and the other fellow's colon is secured above:

surgicalcore.org

Step 3.
When all the fun's been had by the colorectal surgeons, it will then fall to the reconstruction team to secure the bony window musculature, advance the fat grafts and finally advance and close the overlying skin.

Considerations:
It goes without saying that this kind of procedure, though legal in this dictatorship, is highly unethical and immoral in the extreme. The risks to both security officer and high profile prisoner are grave in the extreme, given current technology and understanding of medicine. Obviously the primary complications of this kind of surgery will be like those of similar single-patient procedures:

  • bleeding (i.e., the oops, that wasn't the aorta, was it? kind of bleeding)
  • infection (intestines are dirty and risk of infection is high)
  • biological incompatibility (the risk every organ transplantee faces --- here, you are essentially transplanting a segment of bowel)
  • component failure (problems ranging from skin degradation to muscular fixation degradation)
  • psychiatric dissociation / rejection (either or both victims (I mean, patients!) might fail to come to grips with the new reality of their situation and may consciously or unconsciously seek to physically separate themselves from one another. This would be somewhat disasterous.)
  • death (always a possible complication of surgery. In this case, the death of one patient spells impending doom for the other.)

With current technology, and a bit of slightly futuristic handwaving, as well as throwing out all sense of medical ethics, all of these complications can be addressed. Biological incompatibility can be offset to some greater or lesser extent through medication regimens (antibiotics, anti-rejection drugs, immunosuppresants) and the use of "intermediate" biologically neutral components, for example, bioengineered skin graft products. Death of one patient can really only be mediated by extremely quick access to a trauma center that can stabilise the pair (either by resuscitating or artificially keeping the dead body "alive" by mechanical ventilation and cardiac massage) and quickly transport them to a designated OR that has already planned for this eventuality and is ready to decouple them, basically by reversing the surgeries.

This being a very dark and dystopic society, I'd hazard the guess that the high-profile prisoner is the more important of the two and that every heroic measure will be taken to save that one's life, even at the expense of the other.

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    $\begingroup$ "every heroic measure will be taken to save that one's life" the most effective, of course, would be to not do it in the first place... $\endgroup$ – Starfish Prime Oct 9 '19 at 8:18

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