Page 16 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
The Anatomical Variations of Rouviere’s Sulcus Observed

during Laparoscopic Cholecystectomy in Egyptian Patients

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Bahaa M El Wakeel , Wessam Mostafa Abdellatif , Ashraf Anas Zytoon , Nashwa Ghanem , Mohammed M Mogahed 5
Received on: 04 January 2022; Accepted on: 06 September 2022; Published on: 07 December 2022
AbstrAct
Background: Laparoscopic cholecystectomy (LC) became one of the most common operations worldwide. Bile duct injury usually occurs due to a
failure to recognize the critical structures in Calot’s triangle. A proper knowledge about biliary structures, its anatomicl variations, and identification
of various anatomical landmarks is essential to make LC easy and safe. Although Rouviere’s sulcus (RS) was initially described by Henri Rouviere in
1924, it is not widely known and not often incorporated in LC. In cirrhotic patients, the incidence of gallstones is higher than in general population.
Aim: To determine the frequency and types of RS as seen during LC and to assess the benefits of identifying Rouvier’s sulcus as an anatomical
landmark in avoidance of bile ducts injury during LC in Egyptian patients.
Materials and methods: A prospective study was conducted on 290 patients with gallbladder diseases, 250 non-cirrhotic (group A) and 40
cirrhotic patients (group B) who scheduled for LC at National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt, in
a period of 30 months.
Results: Among group A, RS was clearly identified as a deep sulcus in 190 patients (76%), in 40 patients (16%), RS was identified as a scar, while
it was absent in the remaining 20 patients (8%). Among group B, RS was clearly identified as a deep sulcus in 9 patients (22.5%), in 11 patients
(27.5%), RS was identified as a scar, while it was absent in the remaining 20 patients (50%).
Conclusion: Identification of RS provides an easy landmark for starting dissection of Calot’s triangle for safe LC as it facilitates the identification
of the biliary and vascular structures and minimizes iatrogenic biliary injuries. Identification of RS may not be easy in liver cirrhosis and need
careful dissection of vascular and biliary structures.
Keywords: Laparoscopic cholecystectomy, Liver cirrhosis, Rouviere’s sulcus.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1527

IntroductIon 1,5 Department of Surgery, National Hepatology and Tropical Medicine
In 1420, cholelithiasis was first described by Antonio Benivenius, Research Institute, Cairo, Egypt
and since 1882, cholecystectomy is performed initially by a 2 Department of Radiology, National Hepatology and Tropical Medicine
German surgeon named Johann August, the first surgeon who Research Institute, Cairo, Egypt
performed open cholecystectomy. In 1987, Phillip Mourett was 3 Department of Radiodiagnosis, Interventional Radiology and Medical
the first surgeon performing LC. Cholecystectomy becomes a Imaging, Faculty of Medicine, Menoufia University, Menoufia, Egypt
commonly performed surgical operations worldwide, whereas 4 Department of Internal Medicine, Faculty of Medicine, Cairo
more than 750,000 cholecystectomies are performed yearly in the University, Cairo, Egypt
USA alone. With the era of LC, there was an increasingly number Corresponding Author: Mohammed M Mogahed, Department
of bile duct injuries with the incidence of 0.3–0.5% of LCs, which is of Surgery, National Hepatology and Tropical Medicine, Research
considered a serious complication of this procedure. So, there is an Institute, Cairo, Egypt, Phone: +2 01006435572, e-mail: Mogahed1968@
increasing need for identification of various anatomical landmarks yahoo.com
which makes LC safer. A proper knowledge about anatomical How to cite this article: El Wakeel BM, Abdellatif WM, Zytoon AA,
variations within the Calot’s triangle is the milestone to perform et al. The Anatomical Variations of Rouviere’s Sulcus Observed during
safe cholecystectomy, together with meticulous identification of Laparoscopic Cholecystectomy in Egyptian Patients. World J Lap Surg
cystic biliary and vascular structures is considered the gold standard 2022;15(3):202–206.
to minimize the incidence of biliary tree injuries. 1 Source of support: Nil
As LC now represents the vast majority of cholecystectomies all Conflict of interest: None
over the world due to better cosmetic outcome, less hospital stays,
and minimal rest from work compared to open cholecystectomies.
There is still incidence of complications of LCs including bile easily seen during the posterior dissection for LC in the majority
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duct injuries, bile leakage, and massive bleeding. The strategy of patients. RS, which is a cleft in the liver, could be identified in
for safe LC without surgical complications in addition to the approximately 90% of patients and clearly seen by grasping the gall
proper knowledge about biliary structures and biliary congenital bladder and retracting it medially. The length and depth of RS vary
anomalies, focused on identification of various anatomical in different individuals, and with the increasing number of LCs. This
landmarks that makes LCs easy and safe. 3 sulcus got more importance as a landmark for safe cholecystectomy
In 1924, Henry Rouviere identified an important fissure in the because of its relation to the right portal pedicle which made it a
liver between the right lobe and the caudate process which was gold extrabiliary landmark for safe cholecystectomy. 4–6

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