Journal of Krishna Institute of Medical Sciences University (Oct 2018)
Rouviere's Sulcus as an Anatomical Landmark for Safe Laparoscopic Cholecystectomy
Abstract
Background: Laparoscopic cholecystectomy is associated with more biliary, vascular and visceral complications when compared with open cholecystectomy. This study was undertaken to assess the utility of Rouviere's Sulcus as an anatomical landmark for safe laparoscopic cholecystectomy with reference to: frequency of occurrence, anatomical description and relationship with level of difficulty in performing safe laparoscopic cholecystectomy. Material and Methods: It was a prospective study of 50 patients with symptomatic gall stone disease. The cases were grouped as easy, difficult and very difficult, as per pre-defined criteria. The study included 17 males and 33 females. Majority of patients (34%) were in the age group 21-30 years. Rouviere's Sulcus was identified in 49 patients. Type I Rouviere's Sulcus was the commonest (78%). Results: Out of the 49 cases, in which Rouviere's Sulcus was identified, 30 cases were identified in the 'easy' group and the relationship was statistically significant. The relationship between operating time and level of difficulty in performing laparoscopic cholecystectomy was statistically significant. Out of the 3 patients in whom complications (bleeding and bile spillage) were noted, two patients were in 'difficult' group. Rouviere`s Sulcus is an easily identifiable anatomical landmark for safe laparoscopic cholecystectomy, present as open or fused type. Conclusion: Evidence-based safetyprotocols using validated anatomical landmarks for safe dissection are the need of the hour to reduce the incidence of bile duct injuries after laparoscopic cholecystectomy.
