Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult laparoscopic cholecystectomy

Abstract

Abstract:

ObjectiveTo explore Rouviere′s sulcus guided retro-gallbladder tunnel dissection cholecystectomy used in difficult laparoscopic cholecystectomy.MethodsA retrospective analysis of 1 081 patients with laparoscopic cholecystectomy in Tengzhou Central People′s Hospital from January 2019 to October 2020 was done. A total of 125 cases had scores ≥6 indicating difficult laparoscopic cholecystectomy based on preoperative scoring system to predict difficult laparoscopic cholecystectomy by Gupta. There were 65 cases(study group) with laparoscopic cholecystectomy using Rouviere′s sulcus guided retro-gallbladder tunnel dissection and 60 cases(control group) with routine laparoscopic cholecystectomy. Clinical data with operation and postoperative complication were compared between two groups.ResultsOperative time of two groups was [(61±23) minvs. (88±24) min], operative blood loss [(46±16) mLvs. (62±23) mL, hospital length of stay [(3.5±1.5) dvs. (5.8±2.2) d] and hospital cost [(12 236±316) yuanvs. (14 199±552) yuan] with statistical significant difference (P<0.05). Visual analog scale at 12 h and 24 h after operation in study group were (2.7±1.1) and (3.0±1.1), less than those in control group (5.9±1.0) and (6.4±1.5) significantly(P<0.05). One case with conversion of laparotomy was present in study group and 6 cases in control group (P<0.05). There was no case with bile leakage in study group and 4 cases in control group (P<0.05). Liver function was more improved significantly 72 hours postoperative in study group than in control group (P<0.05). There was no bile duct injury in study group and 1 bile duct injury in control group (P>0.05).ConclusionsRouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult cholecystectomy could be safe laparoscopic cholecystectomy.

Key words:Laparoscopic cholecystectomy,Difficult gallbladder,Rouviere′s sulcus,Retro-gallbladder tunnel

CLC Number:

R657.4

MAN Gaoya, DANG Tongke, WU Qingsong, FENG Feiling. Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult laparoscopic cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2022, 27(03): 239-243.

Figures/Tables6

项目	分值
年龄（岁） ≤50 >50	0 1
性别男女	1 0
既往急性胆囊炎病史有无查体触及肿大胆囊有无影像学检查胆囊壁厚度（mm） <4 ≥4 胆囊颈管结石嵌顿无有胆囊周围粘连无有	4 0 1 0 0 2 0 2 0 1

项目	研究组（n）	对照组（n）	t/χ²	P值
年龄（岁）	49.5±6.1	49.8±5.9	t=0.279	>0.05
性别男女	39 26	37 23	χ²=0.036	0.849
既往急性胆囊炎发作史查体触及肿大胆囊影像学检查胆囊壁厚≥4 mm 胆囊颈管结石嵌顿胆囊周围粘连渗出难度评分分值（分）	6 5 40 12 7 10.5±1.3	5 4 38 11 6 10.7±1.2	χ²=0.031 χ²=0.049 χ²=0.043 χ²=0.000 χ²=0.020 t=0.378	0.863 0.825 0.836 0.985 0.888 >0.05

项目	研究组	对照组	t/χ²	P值
手术时间（min）	61±23	88±24	t=6.422	<0.05
术中出血量（mL）	46±16	62±23	t=4.543	<0.05
胆管损伤胆漏中转开腹住院时间（d）人均住院费（元）	0 0 1 3.5±1.5 12 236±316	1 4 6 5.8±2.2 14 199±552	χ²=1.091 χ²=4.477 χ²=4.225 t=6.875 t=24.634	0.296 0.034 0.040 <0.05 <0.05

项目	时间	研究组	对照组	t值
天冬氨酸转氨酶（U/L）	术前	90.4±5.5	89.9±5.8
术后72 h	23.1±5.1	52.3±6.1	32.822	<0.05
丙氨酸转氨酶（U/L）	术前	79.3±3.8	79.1±4.1
术后72 h	21.8±3.6	47.2±7.5	36.110	<0.05
总胆红素（mol/L）	术前	16.8±2.4	16.7±2.5
术后72 h	15.1±2.1	15.0±2.2	0	>0.05
碱性磷酸酶（U/L）	术前	113.3±5.7	112.9±5.9
术后72 h	68.1±3.0	70.2±4.1	1.538	>0.05

术后时间	研究组	对照组	t值	P值
术后12 h	2.7±1.1	5.9±1.0	16.971	<0.05
术后24 h 术后48 h	3.0±1.1 2.9±1.5	6.4±1.5 3.0±1.6	14.582 0.361	<0.05 >0.05

References30

[1]	Onoe S, Maeda A, Takayama Y, et al. A preoperative predictive scoring system to predict the ability to achieve view of safety during laparoscopic cholecystectomy for acute cholecystitis[J]. HPB(Oxford), 2017, 19(5):406-410.
[2]	Bogacki P, Krzak J, Gotfryd-Bugajska K, et al. Evaluation of the usefulness of the SAGES Safe Cholecystectomy Program from the viewpoint of the European surgeon[J]. Videosurgery Miniinv, 2020, 15(1):80-86. doi:10.5114/wiitm.2019.83297pmid:32117489
[3]	Durowicz S, Kozicki I, Ciesielski A, et al. Excision of a part of the bile duct as an iatrogenic injury typical for laparoscopic cholecystectomy-characteristics,treatment and longterm results,based on own material[J]. Videosurgery Miniinv, 2020, 15(1):70-79.
[4]	Schendel J, Ball C, Dixon E, et al. Prevalence of anato-mic landmarks for orientation during elective laparoscopic cholecystectomies[J]. Surg Endosc, 2020, 34(8):3508-3512. doi:10.1007/s00464-019-07131-z URL
[5]	Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1):73-86. doi:10.1002/jhbp.517 URL
[6]	Kapoor VK. Mechanisms of causation of bile duct injury[M]// Kapoor VK. Post-cholecystectomy Bile Duct Injury. Singapore: Springer, 2020:21-35.
[7]	Gupta N, Ranjan G, Atora MP, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy[J]. Int J Surg, 2013, 11(9):1002-1006. doi:10.1016/j.ijsu.2013.05.037 URL
[8]	Di Buono G, Romano G, Galia M, et al. Difficult laparoscopic cholecystectomy and preoperative predictive factors[J]. Sci Rep, 2021, 11(1):2559. doi:10.1038/s41598-021-81938-6 URL
[9]	Hugh TB, Kelly MD, Mekisic A. Rouviere′s sulcus: a useful landmark in laparoscopic cholecystectomy[J]. Br J Surg, 1997, 84(9):1253-1254.
[10]	Grass K, Oeckl K, Kersting S. The critical view of safety to avoid biliary complications in laparoscopic cholecystectomy[J]. Zentralbl Chir, 2020, 145(4):336-339. doi:10.1055/a-1079-6060 URL
[11]	Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain:visual analog scale for pain(VAS pain), nume-ric rating scale for pain(NRS pain), mcgill pain questionnaire(MPQ), short form mcgill pain questionnaire(sf-MPQ), chronic pain grade scale(CPGS), short form-36 bodily pain scale[J]. Arthit Care Res, 2011, 63(11):240-252.
[12]	Pisano M, Allievi N, Gurusamy K, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis[J]. World J Emerg Surg, 2020, 15(1):61. doi:10.1186/s13017-020-00336-x URL
[13]	Gupta V, Jain G. Safe laparoscopic cholecystectomy: adoption of universal culture of safety in cholecystectomy[J]. World J Gastrointest Surg, 2019, 11(2):62-84. doi:10.4240/wjgs.v11.i2.62 URL
[14]	Stanisic V, Milicevic M, Kocev N, et al. A prospective cohort study for prediction of difficult laparoscopic cholecystectomy[J]. Ann Med Surg, 2020, 12(60):728-733.
[15]	Bhandari TR, Khan SA, Jha JL. Prediction of difficult laparoscopic cholecystectomy: an observational study[J]. Ann Med Surg (Lond), 2021, 12(72):103060.
[16]	Schreuder AM, Busch OR, Besselink MG, et al. Long-term impact of iatrogenic bile duct injury[J]. Dig Surg, 2020, 37(1):10-21. doi:10.1159/000496432 URL
[17]	Christou N, Roux-David A, Naumann DN, et al. Bile duct injury during cholecystectomy: necessity to learn how to do and interpret intraoperative cholangiography[J]. Front Med (Lausanne), 2021, 2(8):637987.
[18]	Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy[J]. Ann Surg, 2020, 34(8):2827-2855.
[19]	Cheruiyot I, Nyaanga F, Kipkorir V, et al. The prevalence of the Rouviere’s sulcus: a meta-analysis with implications for laparoscopic cholecystectomy[J]. Clin Anat, 2021, 34(4):556-564. doi:10.1002/ca.23605 URL
[20]	Jha AK, Dewan R, Bhaduria K. Importance of Rouviere’s sulcus in laparoscopic cholecystectomy[J]. Ann Afr Med, 2020, 19(4):274-277. doi:10.4103/aam.aam_4_20 URL
[21]	Péré G, Benvegnu V, Mercé C, et al. The sulcus of the caudate process (Rouviere’s sulcus): anatomy and clinical applications—a review of current literature[J]. Surg Radiol Anat, 2020, 42(12):1441-1446. doi:10.1007/s00276-020-02529-0 URL
[22]	Shinde J, Pandit S. Innovative approach to a frozon calot,s triangle during laparoscopic cholecystectomy[J]. Indian J Surgery, 2015, 77(6):1-4.
[23]	Way LW, Stewart L, Cantert, et al. Causes and prevention of laparoscopic bile duct injuries analysis of 252 cases from a human factors and cognitive psychology perspective[J]. Ann surg, 2003, 237(4):460-469.
[24]	Cengiz Y, Lund M, Janes A, et al. Fundus first as the standard technique for laparoscopic cholecystectomy[J]. Sci Rep, 2019, 9:18736. doi:10.1038/s41598-019-55401-6pmid:31822771
[25]	Ale AF, Isichei MW, Shilong DJ, et al. Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome[J]. Inter J Res Med Sci, 2020, 8(6):2062-2066. doi:10.18203/2320-6012.ijrms20202244 URL
[26]	Asai K, Atanabe M, Usachi S, et al. Risk factors for conversion of laparoscopic cholecystectomy to open surgery associated with the severity characteristics according to the Tokyo guidelines[J]. Surg Today, 2014, 44(12):2300-2304. doi:10.1007/s00595-014-0838-z URL
[27]	Sormaz IC, Soytaş Y, Gök AFK, et al. Fundus-first technique and partial cholecystectomy for difficult laparoscopic cholecystectomies[J]. Ulus Travma Acil Cerrahi Derg, 2018, 24(1):66-70.
[28]	Mahmud S, Masaud M, Canna K, et al. Fundus-first laparoscopic cholecystectomy[J]. Surg Endosc, 2002, 16(4):581-584. pmid:11972192
[29]	Mannino M, Toro A, Teodoro M, et al. Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects[J]. World J Emerg Surg, 2019; 14(1):10-13. doi:10.1186/s13017-019-0224-7 URL
[30]	Sewefy AM, Hassanen AM, Atyia AM, et al. Retroinfundibular laparoscopic cholecystectomyversusstandard laparoscopic cholecystectomy in difficult cases[J]. Int J Surg, 2017, 7(43):75-80.