Morphological variants of Rouviere's sulcus and its significance in a patient undergoing laparoscopic cholecystectomy: An emerging paradigm.

Abstract

Introduction: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for symptomatic cholelithiasis. To prevent bile duct injuries, various practices are recommended, one of which is the identification of Rouviere's sulcus (RS) and starting dissection above its level. So far, no uniform anatomical description of RS is available in the literature. After prospective observation of 302 patients, we have proposed a new classification based solely on gross morphology. The purpose of this study is to make surgeons well acquainted with its different anatomical variations and its significance for the prevention of complications.

Patients and methods: We performed a prospective analysis of 302 patients during LC, and various morphological variants of RS and its relationship with hepatobiliary anatomy were recorded. We have used the nomenclature as described by previous authors and added a few.

Results: A total of 330 patients were included in our study. We could not visualise the sulcus due to dense adhesion in 28 patients. RS was absent in 24.1% of cases and was present in various forms in 75.8% of cases. Amongst these, the open type was found in 28.8% of cases, fused type was found in 4.8% of cases, groove type was found in 24.8% of cases, pit type was found in 8.2% of cases, close type was found in 14.4% of cases, slit type was found in 8.7% of cases and scar type was found in 10% of cases. Using RS as a landmark, we could perform surgery safely in all cases.

Conclusion: The RS can be described as closed, slit, open, fused, groove, pit or scar type.