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World J Meta-Anal. Sep 18, 2026; 14(3): 123961
Published online Sep 18, 2026. doi: 10.13105/wjma.123961
Rouvière’s sulcus variants from a clinical perspective: A systematic review
Shamir O Cawich, Michael D Kluger, Rahul R Deshpande, Neil W Pearce, Adnan Alseidi, Giovanni Dapri, John N Primrose, Michael T Gardner, Ramnanand S Kedambady, Shaneeta Johnson, D Brock Hewitt, Ammar A Javed
Shamir O Cawich, Shaneeta Johnson, Department of Surgery, Meharry School of Medicine, Nashville, TN 37208, United States
Michael D Kluger, Ammar A Javed, Division of Hepatobiliary and Pancreatic Surgery, NYU Grossman School of Medicine, New York, NY 10016, United States
Rahul R Deshpande, Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
Neil W Pearce, John N Primrose, Department of Surgery, Southampton General Hospital NHS Trust, Southampton SO16 6YD, United Kingdom
Adnan Alseidi, Department of Surgery and Education, University of California, San Francisco, CA 94143, United States
Giovanni Dapri, Department of Surgery, International School Reduced Scar Laparoscopy, Brussels 1050, Belgium
Michael T Gardner, Section of Anatomy, Basic Medical Sciences, University of the West Indies, Kingston 000000, Jamaica
Ramnanand S Kedambady, Section of Anatomy, Department of Basic Medical Sciences, University of the West Indies, Kingston KIN7, Jamaica
D Brock Hewitt, Department of Surgery, The NYU Grossman School of Medicine, School of Medicine, New York, NY 10016, United States
Author contributions: Cawich SO designed the study; Cawich SO, Kluger MD, Pearce NW, Alseidi A, Johnson S, Gardner MT performed the research; Pearce NW, Primrose JN, Deshpande RR and Dapri G analyzed the data; Cawich SO, Kluger MD, Pearce NW, Gardner MT wrote the paper; Cawich SO, Kluger MD, Hewitt DB, Pearce NW, Gardner MT, Alseidi A, Kedambady RS, Johnson S, Primrose JN, Deshpande RR, Javed AA, Johnson S and Dapri G revised the manuscript for final submission.
AI contribution statement: Artificial Intelligence was not used in any way in the preparation or writing of this manuscript.
Institutional review board statement: This research has been approved by the institutional ethics committee.
Informed consent statement: This study only requires data collection and analysis, and does not include any patient identification information. Therefore, there is no need for a patient consent form.
Conflict-of-interest statement: The authors declare that there are no financial relationships, personal relationships or other scenarios that may represent potential conflicts of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: Not applicable.
Corresponding author: Shamir O Cawich, Department of Surgery, Meharry School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, United States.
socawich@hotmail.com
Received: June 2, 2026
Revised: June 27, 2026
Accepted: July 29, 2026
Published online: September 18, 2026
Processing time: 101 Days and 15.3 Hours
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.
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.
