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A CASE SERIES STUDY TO KNOW ADVANTAGE OF THE ROUVIERE'S SULCUS AS AN ANATOMICAL MARKER FOR SAFE DISSECTION IN LAPROSCOPIC CHOLECYSTECTOMY

Tuffail Raffay Azam, Taimoor Naveed Cheema, Jahangir Javed Kalyar, Zardad Khan

Objective: To evaluate the prevalence of Rouviere's sulcus in our population. Study design: A Case Series. Location and duration: This study was conducted the Surgical Department of Services Hospital, Lahore for a duration of one year from June 2017 to May 2018 after the approval from the ethical committee. Methodology: Consecutive patients with symptomatic cholelithiasis and who were operated on with laparoscopic cholecystectomy were selected for the study. The type and frequency of Rouviere’s sulcus were recorded in an operational note. The open-type of sulcus was delineated as a cleft in which the right hepatic pedicle was seen and the entire length of the sulcus was open. The fused-type sulcus is defined as a cleft where the pedicle cannot be visualized or is only open at the lateral end of the sulcus. Results: A total of 160 subjects who underwent laparoscopic cholecystectomy were selected for the analysis. The open-type Rouviere sulcus was visualized in 48 patients and the furthest, disparate type was fused in 61 patients. Therefore, collectively, a total of 109 patients (68.13%) demonstrated the presence of Rouviere's sulcus. Conclusion: Rouviere sulcus is an imperative extra-biliary sign that can be defined as open or fused in most patients. Defining the sulcus prior to commencing the dissection of the Calot triangle can help prevent bile duct injury, improving surgical prognosis. Key Words: laparoscopic cholecystectomy, extrinsic landmark, lesion of bile duct, Calot's triangle, Rouviere sulcus

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