Rouviere's sulcus - An anatomical landmark for safe laparoscopic cholecystectomy: A cross-sectional study.

Introduction: Laparoscopic cholecystectomy (LC) has been established as the gold standard treatment for symptomatic gallstones, however surgeons face the risk of injuring bile ducts and vessels due to the inherent limitations of laparoscopy.

Methods: This is a cross-sectional study done in the Department of Surgery, Shree Birendra Hospital (SBH) on patients who were posted for LC. The study period was through April 2021 to September 2021. During LC, the anatomy of RS was noted and classified into Group A (RS present) or Group B (RS absent). Data analyses were performed considering a p-value of <0.05 as statistically significant.

Results: RS was present in 169 (93.9%) out of 180 cases. The open sulcus type was found in 114 cases (67.5%), followed by closed type in 26 (15.4%), slit sulcus type in 22 (13.0%), and scar type in 7 (4.1%) cases. Injury to cystic artery occurred in one case (0.15%) of Group A while in two cases (18.18%) of Group B (p-value = 0.001). The adjusted operative time in Group A and Group B were 50.61 ± 10.33 min and 69.86 ± 15.28 min respectively (p-value = 0.005). There was significant difference between Group A and Group B in conversion to open surgery - 01 (0.59%) and 04 (36%) respectively (p-value < 0.001). Surgical Site Infection (SSI) was detected in nine (5.33%) cases among Group A and in three (27.2%) cases among Group B (p-value = 0.028).

Conclusion: RS can be considered as an important anatomical landmark for safer LC with fewer injuries to cystic artery, SSI, conversion to open surgery and shorter operative time.