The Current Applications in Surgery of Three-Dimensional Modelling Technology for Complex Fistula-In-Ano: A Systematic Review

Abstract

Background: Complex fistula-in-ano (FIA) poses significant clinical challenges due to its intricate anatomy and high recurrence rates. Traditional imaging techniques like MRI are limited by their two-dimensional (2D) nature, prompting the use of three-dimensional (3D) modeling for enhanced visualization.

Methods: This systematic review, adhering to PRISMA guidelines, analysed 17 studies using 3D models for surgical planning, education, and patient engagement in managing complex FIA. A risk of bias assessment was conducted using the Cochrane Risk of Bias Tool for randomized studies and ROBINS-I for non-randomized studies, revealing that all included studies had at least a moderate risk of bias.

Results: Three-dimensional models improved anatomical visualization compared to 2D MRI, potentially enhancing surgical planning accuracy and reducing recurrence rates. They also offered educational benefits for surgeons and patients. However, the evidence is limited by methodological weaknesses such as small sample sizes and subjective outcome measures.

Conclusion: Three-dimensional modelling technology shows promise in improving surgical precision and patient outcomes for complex FIA, but further high-quality research is needed to validate its clinical utility due to methodological weaknesses in current studies.

Keywords: fistula‐in‐ano; patient education; surgical education; surgical planning; three‐dimensional modelling.

FIGURE 1

PRISMA search identifying 188 records for screening, 15 for retrieval, 13 for eligibility, and 4 additional studies not captured in the search strategy. Seventeen studies included in the review. *Search strategy in Appendix. **Excluded as no direct application of 3D modelling in anal fistulae.

FIGURE 2

Multiple 3D models of complex fistulae. (a) 3D printed model with perianal skin, rectum and fistulae tract [4]. (b) 3D virtual model of fistulae tract with urethra and penis overlayed to demonstrate close proximity [5]. (c) 3D virtual model fistulae tract with openings lettered [6]. (d) Phone compatible 3D application to demonstrate fistulae peri‐operatively (including intra‐operatively) [19]. (e) Generic 3D fistula models designed specifically for patient education [18]. (f) 3D virtual model of fistulae with clock face superimposed [10].