Dear Authors, with great interest we read your recently published article on "Rouviere's sulcus variants from a clinical perspective" in World Journal of Meta-Analysis. Our main concern is the following issue. In the systematic review, three systematic reviews/meta-analyses are also included. These are: - reference No 39, Cheruiyot et al 2021, with 4495 cases - reference No 46, Manatakis et al 2022, with 6761 cases - reference No 55, Cirocchi et al 2024, with 1802 cases. Upon checking the original papers included within these three reviews, we found that certain original studies are therefore double-, triple- or quadraple- (mis)calculated for the final number of 25196 patients. Moreover, the study by Smithmaitrie et al 2024 included a total of 3200 still captions of 40 laparoscopic cholecystectomy cases, with 80 frames captured from each individual video, to train an AI model. Therefore, these are not 3000 individual cases, as reported in Table 2. We believe that this is a major methodological flaw of the review, as it severely affects both the numerator and the denominator, when calculating the global prevalence of Rouviere's sulcus. The true number of individual cases, based on the original anatomical studies, is much less than 25000, and this creates a certain confounding. with best wishes, Dimitrios Manatakis Consultant General Surgeon Athens, Greece email: dmanatak@yahoo.gr d.manatakis@hellenicnavy.gr