Rouvière’s sulcus variants from a clinical perspective: A systematic review

Abstract

BACKGROUND

Rouvière’s sulcus is an important anatomic structure that may protect against bile duct injuries and guide parenchymal transection during hepatectomies. However, there are still multifarious classifications in use that prevent proper analysis of existing data.

AIM

To identify all existing data using a uniform classification of Rouvière’s sulcus.

METHODS

This study had two parts. First, a 5-year observational study of all consecutive cholecystectomies in an Eastern Caribbean nation was performed. Data were categorized using a standardized classification identifying open, closed, slit and scar-type variants. The second part of the study was a systematic literature review of medical archiving platforms, searching Rouvière’s sulcus variants. In instances where other classifications were used, we studied the descriptions and published images in order to categorize data using the standardized classification. The raw data were used to calculate global prevalence for each variant, which was then compared to that in our population using χ² tests to compare contingency tables in SPSS version 20 (IBM Corp, Armonk, NY, United States). Fisher exact tests were used for values < 5. A P value < 0.05 was considered significant.

RESULTS

Data were collected from 356 persons in the observational study, revealing that Rouvière’s sulcus was present in 296 (83.2%) individuals. We encountered 140 open-type, 69 closed-types, 65 slit-types and 22 scar-type variants. There were 57 relevant articles from the systematic review that reported 76.88% global prevalence of Rouvière’s sulcus in 25196 persons. This was significantly lower than the prevalence of Rouvière’s sulcus in our population (83.2%; P = 0.005306). The Eastern Caribbean population was unique for having significantly lower proportions of open-type variants (39.33% vs 56.69%; P < 0001), and greater proportions of slit-type variants (18.26% vs 14.15%; P = 0.033397). The global prevalence of the closed-type Rouvière’s sulcus (23.64% vs 19.38%; P = 0.061988) and the scar-type Rouvière’s sulcus (8.11% vs 6.18%; P = 0.188331) were similar to that in Eastern Caribbean.

CONCLUSION

Although persons of Eastern Caribbean descent have a greater prevalence of Rouvière’s sulcus than global statistics, there are important differences in the proportion of variants. Surgeons practicing in these regions must be aware of these differences, particularly the lower prevalence of the “classic” open-type sulcus, as the other variants are more difficult to recognize intra-operatively.

Keywords: Liver; Rouvière; Sulcus; Groove; Variants

Core Tip: Even in the year 2026, there is no consensus on a definition nor classification system for Rouvière’s sulcus, despite it being an important surgical landmark. In this systematic review, we used a standardized definition and classification system to extract raw data from 57 articles encompassing 25196 persons and used this to calculate the global prevalence of each variant of Rouvière’s sulcus. These data were compared to the data from a 5-year observational study in our local population. Statistical analyses revealed that the prevalence of Rouvière’s sulcus was significantly greater in the Caribbean population than global prevalence (83.2% vs 76.88%; P = 0.005306). Other unique differences were significantly lower proportions of open-type variants (39.33% vs 56.69%; P < 0001), and greater proportions of slit-type variants (18.26% vs 14.15%; P = 0.033397). These are important differences in the proportion of variants that are of great importance to surgeons practicing in these regions.