Prevalence and structural variants of Rouviere’s sulcus in a sample of Kenyan livers: A cadaveric study with implications for laparoscopic cholecystectomy

Abstract

[Accepted Research Article]

Background: The sudden increase in the number of centers offering laparoscopy services in our setting and the wide acceptance of laparoscopic cholecystectomy (LC) has generated a large volume of procedures being performed by surgeons with limited experience in this area, resulting in a surge of the number of complications. Knowledge of important anatomical landmarks may help prevent damage of important structures during LC.  Rouviere’s Sulcus (RS) is one such landmark whose utility in preventing bile duct and vascular injury during LC is highly recognized. The aim of the study was to determine the frequency and anatomical variants of the RS in the Kenyan population.

Methods: This cadaveric study was carried out at the department of Human Anatomy, University of Nairobi. One hundred and sixteen (116) livers were examined to assess the presence of, and the anatomical variant types of Rouviere’s sulcus.

Results: The sulcus was present in 98 of the livers (84.5%). Type 1A was seen in 54.3%, 1B in 12.1%, type 2 in 9.5% and type 3 in 8.3%. The sulcus was absent in 18(15.5%) of the livers.

Conclusion: Rouviere’s sulcus is a frequent anatomical landmark present in 84.5% of the livers of the Kenyan population studied, either as open or fused type. It can therefore be reliably used as a landmark in LC to avoid bile duct and concomitant vascular injury and to enable vascular control during segmental surgery of the right liver.