Results
This is a prospective descriptive study which included 155 patients
who underwent laparoscopic cholecystectomy in Menoufia Liver institute
Hospitals to determine the frequency and the type of Rouviere’s sulcus
and its importance as landmark during laparoscopic cholecystectomy.
Total cases included in the study
(n = 155)
After proper traction of gallbladder
RS visible initially RS not visible initially
(n =107) (n =48)
Reason for non-visible RS
Omental adhesion (n =15)
Omental and bowel
adhesion (n =5)
Absence of RS (n =28)
RS became visible later After release of adhesions
andoooooomentum
RS present RS absent
(n =127) (n =28)
Table 1: Baseline characteristics of the study participants
Study participants
(n =155)
Age Mean ± SD 41.83 ± 11.39
(years) Range 17 – 70
Male 60 (38%)
Gender
Female 95 (62%)
The age of the study cases ranged from 17 to 70 years old with a
mean value of 41.83 ± 11.39 years. 60 (38%) cases were males while 95
(62%) were females.
60
50
40
30
years
20
10
0
Age
Figure 1: Age of the study participants
70%
62%
60%
50%
% of study participants
40% 38%
30%
20%
10%
0%
Males Females
Figure 2: Gender of the study participants
Table 2: Preoperative data of the study participants
Study
participants
(n =155)
Symptomatic
65 (42%)
gallstone
Acute cholecystitis 44 (27%)
Biliary pancreatitis 18 (12%)
Indications of Asymptomatic
cholecystectomy 7 (5%)
gallstone
CBD stones 11 (7%)
Polyp 6 (4%)
Other indications 4 (3%)
Presentation with acute Yes 75 (48%)
attack No 80 (52%)
CBD: Common bile duct
Regarding the indications for cholecystectomy, the most common
indication in the study participants were symptomatic gall stones in 65
(42%) cases followed by acute cholecystitis in 44 (27%) cases and biliary
pancreatitis in 18 (12%) cases. The least common indications were CBD
stones and asymptomatic gall stones in 7 (5%) and 11(7%) cases
respectively. Polyp in 6 (4%) and other indication as noncalcular
cholecystitis in 4 (3%) cases.
75 (48%) cases were presented with acute attack and 80 (52%) cases
were not.
40%
42%
35%
30% 27%
25%
% of study participants
20%
12%
15%
10%
11%
5% 4%
5% 3%
0%
on
e tis tis es e lyp on
s
t ys
ti
ati on on Po ti
ll s
ec re s t ls t ca
ga ol c D g al di
c ch an CB tic
in
ati e yp a he
r
om ut a r
om
t
pt Ac B ili pt
O
m ym
Sy
As
Figure 3: Indications of cholecystectomy in the study participants
60%
50%
40%
30%
20%
10%
0%
Yes No
Figure 4: Presentation with acute attack in the study participants
Table 3: Intraoperative data of the study participants
Study participants
(n =155)
Present 20 (13%)
Adhesions
Not present 135 (87%)
Visible 136 (88%)
Rouviere’s Sulcus
Not visible 19 (12%)
Above 109 (70%)
Calot dissection
At or below 46 (30%)
Yes 2 (1%)
Biliary injury
No 153 (99%)
Yes 2 (1%)
Blood loss
No 153 (99%)
Conversion to Yes 4 (2%)
open No 151 (98%)
Regarding intraoperative data, adhesions were present in 20 (13%)
cases, sulcus was visible in 136 (88%) cases.
Calot dissection was done above in 109 (70%) cases and at or below
in 46 (30%) cases, biliary injury, blood loss occurred in 2 (1%) and 2
(1%) cases respectively.
One case of biliary injury occurred in RS non visible in the form of
CBD injury, diagnosed intraoperative and managed by
hepaticojejunostomy after conversion to open. One case of biliary injury
occurred in RS visible in the form of bile leak from cystic duct stump,
diagnosed postoperative and managed by ERCP with stent.
In all cases, only 4 (2%) were converted to open cholecystectomy in
the form of technical problem (1 cases). Severe adhesion and
inflammation (1 cases).distorted anatomy (1 cases) and biliary injury
(1case)
No 87% YES 13%
Figure 5: Presence of adhesions in the study participants
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Present Absent
Figure 6: Presence of sulcus in the study participants
Above 70% At or below 30%
Figure 7: Calot dissection in the study participants
60%
50%
40%
30%
20%
10%
0%
Yes No
Figure 8: Biliary injury in the study participants
60%
50%
40%
30%
20%
10%
0%
Yes No
Figure 9: Blood loss in the study participants
100% 98%
90%
80%
70%
% of study participants
60%
50%
40%
30%
20%
10%
2%
0%
yes no
Figure 10: Conversion to open cholecystectomy in the study
participants
Table 4: Postoperative data of the study participants
Study participants
(n =155)
Present 5 (3%)
Collection
Not present 150 (97%)
Present 2 (1%)
Biliary leak
Not present 153 (99%)
Occurred 4 (2%)
Postoperative wound
infection Didn’t
151 (98%)
occur
Present 148 (95%)
Drain
Not present 7 (5%)
Regarding postoperative data in the study participants, collection
was present in 5 (3%) cases and biliary leak in 2 (1%) cases.
Postoperative wound infection occurred in 4 (2%) cases and drain
was present in 148 (95%) cases.
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Yes No
Figure 11: Presence of collection in the study participants
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Yes No
Figure 12: Biliary leak in the study participants
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Yes No
Figure 13: Postoperative wound infection in the study participants
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Yes No
Figure 14: Drain in the study participants
Table 5: Duration of operation and hospital stay in the study
participants
RS P value
not
RS visible visibl
(n =107) e
(n
=48)
122.7
Mean ± 107.76 ±
5±
Duration of operation SD 25.14 <0.001
19.11
(minutes) *
100 -
Range 75 – 180
184
Length of hospital Mean ± 2.75 ±
1.48 ± 0.53
stay SD 1.15 0.008*
(days) Range 1–3 1–5
SD: Standard deviation, IQR: Inter quartile range
Duration of operation and length of hospital stay were significantly
longer in patients whom RS were not visible than those who were visible
(p <0.001, =0.008 respectively).
125
Duration of operation 120
115
110
105
100
RS visible RS not visible
Figure 15: Duration of operation in patients with or without visible
RS
2.5
2
Length of hospital stay
1.5
0.5
0
RS visible RS not visible
Figure 16: Length of hospital stay in patients with or without visible
RS