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Complex perianal fistula and pelvic tumours have challenging anatomical pathologies that can hinder successful surgical outcomes. Surgical treatment of such conditions requires good spatial orientation and the ability to interpret two-dimensional imaging in terms of three-dimensional (3D) pathology. 3D printed anatomical models can improve the accuracy and outcome of surgical treatments, as preoperative planning adjuncts and intraoperative reference guides, while serving as tools for medical and patient education. We provide a brief review on the application of 3D printing in colorectal surgery, with a focus on complex perianal fistula and pelvic tumours. We describe our experience in the usage of 3D printed models in colorectal procedures in this pilot study. Pelvic MRI was performed on a 3.0 Tesla scanner and the images were segmented and designed by 3D printing engineers with input from clinicians. The fistula model was printed using a combination of fused deposition modelling and stereolithography 3D printing techniques. Five patients had 3D printed models of their complex perianal fistulae created and one pelvic model of a complex tumour was made. An example of one fistula model and its use intraoperatively is shown with positive feedback from the performing surgeon. The models used different colours for different anatomical structures and could be disassembled into separate parts. Patient-specific 3D printed models are useful tools in visualising complex perianal fistula and pelvic anatomy, enhancing surgical treatment and education. Such models may become standard adjuncts in helping surgeons better understand individual patient pathology.