Prevalence of Rouvière's sulcus and its anatomical variations: our experience and systematic review/meta-analysis

Introduction: Rouvière's sulcus, an anatomical landmark, has been proposed as a potential aid in enhancing surgical safety. This study aims to assess the prevalence of RS and its anatomical variations both in the existing literature and within our clinical practice. Evidence acquisition: A systematic literature search was conducted, and relevant studies were identified. Evidence synthesis: Fourteen studies were obtained from literature search and we added data extracted during our clinical practice, considering them as the fifteenth study (1802 patients enrolled). In the 15 studies analyzed, the overall pooled prevalence estimate of the Rouvière's sulcus was 82.6%. The study heterogeneity was high, I2=87.8%. The subgroup analysis showed negligible difference between studies with cadaveric dissection (PPE=82.6%) and laparoscopic dissection (PPE=82.6%). The analysis of variations according to Singh and Prasad criteria shows that the Type 1A was the most common variation (60.1%). The prevalence of other types was lower:14.2% in Type 1B, 17.3% in Type 2 and 8.5% in Type 3. Conclusions: Rouvière's sulcus is identified in the majority of patients undergoing LC, and starting the dissection after its recognition can represent a method to reduce IBDI. Considerable heterogeneity exists in the anatomical variations and further research is ongoing to evaluate an association between the variations and technical complexity associate at risk of iatrogenic bile duct injuries.