Page 18 - World Journal of Laparoscopic Surgery

Anatomical Variations of Rouviere’s Sulcus in Egyptian Patients
Table 1: Data collected about the RS in group A
RS Number of patients Percentage
(A) Sulcus 190 76
Open 136
Closed 54
(B) Scar 40 16
(C) Absent 20 8

There were 220 patients (88%) complaining from chronic calcular
cholecystitis, 10 patients (4%) were suffering from obstructive jaundice
Fig. 4: Absent RS in cirrhotic liver and performed endoscopic retrograde colangiopancreatography
(ERCP) 1–3 months before cholecystectomy, and the remaining 20
patients (8%) complaining from acute cholecystitis.
Among group A (250 patients), RS was clearly identified as a
deep sulcus in 190 patients (76%) (136 with open sulcus and 54
with closed sulcus), in 40 patients (16%), RS was identified as a
scar, while it was absent in the remaining 20 patients (8%). Among
group B (40 patients), RS was clearly identified as a deep sulcus in
9 patients (22.5%) (3 with open sulcus and 6 with closed sulcus), in
11 patients (27.5%) RS was identified as a scar, while it was absent
in the remaining 20 patients (50%).
Among the 190 patients with clearly identified RS, 130 patients
(68.4%) underwent an easy and straight forward LC, while in the
60 patients (31.6%), 10 of them (4%) had accessory artery arising
from the gall bladder bed, 40 of them (16%) took more time for
delineation of the biliary anatomy due to either very short cystic
duct or sessile gall bladder, the remaining 10 patients (4%) five of
them were converted to open cholecystectomy due to failure to
identify the bile ducts safely due to frozen Calot’s triangle, and the
other 5 had empyema of the gall bladder and necessitate aspiration
prior to clamping of the gall bladder.
Among the 250 patients’ cholecystectomies, no injury to the
bile ducts was suspected or reported in all patients, 10 patients
(4%) developed hematoma at the site of the gall bladder bed
which was small and resolved spontaneously with no intervention,
while 5 patients (2%) developed bile leak through the drain by the
second day which continued for 1 week and gradually stopped with
no residual abdominal collection. Also, 130 patients (52%) were
discharged from the hospital in the same day of the operation, 100
Fig. 5: RS open type. Note: Figures 4 and 5 were taken from recipient patients (40%) were discharged on the next day, 15 patients (6%)
during liver transplantation for demonstration stayed in hospital for 2 days, while the remaining patient (2%) left
the hospital after one week. No mortality was recorded during this
done using electrocautery, and drain is put in the Morisson pouch, study. The data collected about the RS in group A are described in
and the four wounds were closed. Table 1 and Figure 6.
Figure 4 shows absent sulcus and Figure 5 shows closed sulcus With regard to group B (cirrhotic patients), total of 40 child A
in cirrhotic patients obtained during liver transplantation just for patients subjected to LC in 30 months.
demonstration. Among the 40 patients, RS was absent in 20 patients
(50%), while in 9 patients (22.5%), RS was identified as a scar,
results and it was identified as a sulcus in the remaining 11 patients
We divided the patients into two groups: group A: Non-cirrhotic (27.5%).
(250 patients) and group B: cirrhotic (40 patients). Twelve patients underwent a relatively easy and straight forward
In group A, a total of 250 surgically fit patients subjected to LC (8 patients with identified sulcus and 4 of the 11 patients with the
elective LC in 30 months, 185 (74%) were females and 65 (26%) were sulcus identified as a scar), while in 28 patients (one with sulcus, 7
males with a mean age of 45.2 ± 6.1 years, (range, 22–55 years). In with just scar and 20 with absent RS) the operations were relatively
group B, 40 surgically fit patients, child A 29 (72.5%) were females more time consuming and more technically difficult. Two cases
and 11 (27.5%) were males with a mean age 53.7 ± 7.1 years (range, of those 28 patients were aborted without cholecystectomy due
38–61 years). to advanced cirrhosis than expected, so the expected hazard is

204 World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022)