Citation Information :
Wakeel BM, Abdellatif WM, Zytoon AA, Ghanem N, Mogahed MM. The Anatomical Variations of Rouviere's Sulcus Observed during Laparoscopic Cholecystectomy in Egyptian Patients. World J Lap Surg 2022; 15 (3):202-206.
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.
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