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

Abstract

Background: The sudden increase in the number of centres offering laparoscopy services in our setting and the wide acceptance of laparoscopic cholecystectomy (LC) have led to a large volume of procedures being performed by surgeons with limited experience in this area, resulting in a surge in the number of complications. Knowledge of important anatomical landmarks may help prevent damage to important structures during LC. Rouvière’s Sulcus (RS) is such a landmark whose utility in preventing bile duct and vascular injury during LC is highly recognized. This study aimed to estimate the frequency and anatomical variants of RS in the Kenyan population. Methods: This cadaveric study was conducted at the Department of Human Anatomy, University of Nairobi. One hundred sixteen livers were examined to assess for the presence of RS and anatomical variants. Results: RS was identified in 98 of the 116 examined livers (84.5%). The deep RS variant was found in 77 livers (66.4%), with its subtypes—continuous with the hepatic hilum medially vs fused medially—present in 63 (54.3%) and 14 (12.1%) livers, respectively. The shallow and scar-like RS types were observed in 11 (9.5%) and 10 (8.6%) livers, respectively. In 18 livers (15.5%), RS was not identified. Conclusions: RS is a frequent anatomical landmark present in 84.5% of the livers of the Kenyan sample studied, either as an 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.