Rouviere’s Sulcus, A Safe Landmark for Laparoscopic Cholecystectomy

Abstract

Aim: The objective of this study is to determine the frequency of Rouviere’s Sulcus along with its types, Open or Fused in our population and its importance to avoid bile duct injury in laparoscopic cholecystectomy. Study Design: Descriptive case study Setting and Duration: Surgery Department of King Edward Medical University (KEMU), Mayo Hospital Lahore from April 2017 to September 2018. Methodology: A total of 131 patients of both genders were included in this study, who presented with symptomatic gall stones confirmed on ultrasound and underwent laparoscopic cholecystectomy. Keeping in view the importance of rouviere’s sulcus during surgery before starting the dissection of gall bladder in calot’s triangle, the Rouviere’s sulcus was identified and its types open or fused noted and documented in operative notes, then Rouviere’s sulcus if present was taken as a landmark to start dissection, as cystic duct and cystic artery lies invariably above the sulcus. Open type, defined as one which was open throughout its length and in which right hepatic pedicle was visualized. Results: A total of 131 patients underwent laproscopic cholecystectomy which were included in this study. Open type of rouviere’s sulcus was visualized in 57 patients and 41 patients had fused type of sulcus. Hence in a total of 98(74.80%) patients rouviere’s sulcus was visualized. All laparoscopic cholecystectomies performed using Rouviere’s sulcus as landmark for dissection were uneventful without any risk to CBD. Conclusion: Rouviere’s sulcus is important frequent extra biliary landmark, present in majority of patients as Open or Fused type. We recommend that surgeons must identify it as a initial step in laparoscopic cholecystectomy and start dissection above this point in order to prevent bile duct injury during surgery.