Introduction: Perianal Crohn's disease (CD) remains challenging to treat despite the increasing number of advanced therapies. Advanced dual‐targeted therapy has emerged as a new treatment option in CD, but no data are available for perianal CD. The aim of this study was to evaluate the effectiveness and safety of advanced dual‐targeted therapy for anoperineal fistulas (APFs) in CD patients.Materials and Methods: We prospectively included all consecutive patients receiving an advanced dual‐targeted therapy for APFs from August 2019 to December 2023 in a single tertiary perianal CD centre. The primary outcome was clinical effectiveness. Secondary outcomes were patients' treatment perception, radiological effectiveness, luminal disease effectiveness, impact on extra‐intestinal manifestations, and safety. Factors associated with complete clinical remission of APFs were identified using logistic regression.Results: A total of 33 patients were included. The most frequently used advanced dual‐targeted therapy was a combination of infliximab and ustekinumab (75.8%). After a median follow‐up of 27.4 months, 48.5% and 97.0% of patients were in complete clinical remission and reported a perceived improvement, respectively. Complete radiological remission was achieved in 24.2% of the patients. A concomitant improvement in luminal intestinal involvement was observed in 46.1% of cases, and in extra‐digestive manifestations in 45.8% of cases. Treatment tolerance was considered good or very good in 90.9% of cases. Associated anal ulcers and long‐term exposure to antibiotics were associated with a lower likelihood of complete clinical remission for fistulas.Conclusion: These findings suggest that advanced dual‐targeted therapy is a valid option with a good safety profile for the treatment of refractory APFs. Larger studies are required to identify the most effective combination.

Background: Perianal Crohn’s disease (pCD) is one of the most disabling complications of inflammatory bowel disease, characterized by fistulas and abscesses that demand precise imaging for diagnosis, treatment planning, and follow-up. Magnetic resonance imaging (MRI) is considered the reference standard, but endoanal ultrasound (EAUS) with high-frequency 360° probes provide a readily available, cost-effective, and repeatable alternative. Methods: We performed a narrative review of the literature, evaluating studies on the EAUS technique, diagnostic applications, distinguishing features of Crohn’s-related fistulas, and comparative analyses with MRI. Consensus documents and structured reporting initiatives were also included. Results: EAUS provides high-resolution visualization of the anal sphincter complex and intersphincteric space, enabling the reliable detection of fistulas and abscesses. Characteristic features such as tract width > 4 mm, bifurcation, hyperechoic debris, the Crohn’s Ultrasound Fistula Sign (CUFS), and the rosary sign assist in differentiating Crohn’s from cryptoglandular fistulas. EAUS is well-suited for serial monitoring, perioperative seton guidance, and therapeutic decision-making. Emerging tools such as Doppler and shear wave elastography provide additional information on activity and fibrosis. MRI remains indispensable for supralevator disease, deep pelvic sepsis, and standardized activity indices. Comparative studies indicate similar sensitivity for simple fistulas, with MRI superior in complex cases; combining both modalities maximizes accuracy. Conclusions: EAUS is a practical and repeatable imaging tool that complements MRI in the multidisciplinary management of perianal Crohn’s disease. Advances such as 3D imaging, contrast enhancement, and elastography may enable validated activity scoring—for example, a future PEACE (Perianal Endosonographic Activity in Chron’s Evaluation) Index—further strengthening its role in longitudinal care.

Background: Simulation-based laparoscopic training increasingly relies on portable, low-cost platforms that support home-based practice, but detailed descriptions of reproducible, do-it-yourself (DIY) trainers and their educational potential remain limited. Methods: We updated a low-budget laparoscopic simulator constructed from an inexpensive plastic container, wood components, a low-cost webcam, and plywood task pads modeled on Fundamentals of Laparoscopic Surgery (FLS) exercises. We then conducted informal qualitative usability testing in which 10 residents and 5 fellows from general surgery, gynecology, and urology used the simulator at home for one week and completed an eight-item feedback form plus free-text comments on assembly, ergonomics, realism, and educational value. Results: All participants successfully assembled and used the simulator; most described set-up as easy or intuitive, reported adequate image quality and lighting, and considered the platform useful for practicing depth perception, bimanual coordination, and cutting and suturing tasks. Feedback emphasized low cost, portability, and cross-specialty applicability, with only minor suggestions such as adjustable camera height or increased base weight. Conclusions: This DIY laparoscopic simulator could be assembled and used in a home-based setting, and trainees reported favorable usability and perceived educational value. More structured validation studies addressing face, content, and construct validity are needed to define its potential role within contemporary surgical curricula.