Rouviere’s sulcus: a surgical GPS guiding laparoscopic cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy is the gold standard for managing gallstone disease but carries a risk of bile duct injury, particularly in cases of difficult anatomy or inflammation. Rouviere’s sulcus, an extrahepatic biliary landmark, has been proposed as a guide to safer dissection. This study aimed to determine the prevalence and anatomical variations of Rouviere’s sulcus in patients undergoing laparoscopic cholecystectomy and evaluate its role in preventing biliary tract injuries.

Methods: A prospective descriptive study was conducted between January 2021 and August 2022 involving 100 patients undergoing laparoscopic cholecystectomy at a tertiary care teaching hospital. The presence, type, and clinical utility of Rouviere’s sulcus were documented, along with intraoperative and postoperative outcomes. Demographic, clinical, and surgical data were recorded and statistically analyzed.

Results: Rouviere’s sulcus was identified in 79% of patients. The most common type was the open sulcus (60.75%), followed by closed (20.25%), slit (12.65%), and scar (6.32%) types. The conversion rate to open surgery was 21%, with reasons including difficult dissection, uncontrolled bleeding, bile duct injury, and bowel injury. Bile leak occurred in 5% of cases; four managed conservatively with endoscopic retrograde cholangiopancreatography (ERCP), and one required surgical management. No mortality was observed.

Conclusions: Rouviere’s sulcus is a reliable anatomical landmark present in the majority of patients, aiding in safe dissection and reducing bile duct injury risk during laparoscopic cholecystectomy. The routine identification and use of this landmark should be incorporated into surgical practice, although awareness of its absence or difficult visualization in a minority of cases is essential.