الفهرس 
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Abstract
This prospective study included 155 patients who had symptomatic
gallstone disease and underwent laparoscopic cholecystectomy in National
liver Institute – Menofia University.
The results of our present study shows that as follows:
The age of our study participants ranged from 18 to 70 years old with
a mean value of 41.83 ± 11.39years.
This study revealed that, 60(38%) participants were males while 95
(62%) were females.
The rouviere’s sulcus was found in 80 female patients (63%) and in
47 male patients (37%).
The most common indication in the study participants were biliary
pain in 64 (41%) of participants followed by chronic calcular
cholecystitis 25(16%) cases then acute cholecystitis in 20 (13%)
participants and biliary pancreatitis in 18 (11%) participants. The
least common indications were CBD stones and asymptomatic gall
stones in 11 (7%) and 7(5%) participants respectively. Polyp in
6(4%) and other indication as noncalcular cholecystitis in 4(3%)
participants.
The correlation of the RS to the GB stones was found as follow , the
cases with biliary pain the RS was present in 50 (78%) of biliary pain
cases . The cases with chronic calcular cholecystitis the RS was
present in 20 (80%) of chronic calcular cholecystitis cases. The cases
with acute cholecystitis the RS was present in 17(85%) of acute
cholecystitis cases.
Calot dissection was done above in 109 (70%) cases and at level of
the Rouvier’s sulcus in 46 (30%) cases, biliary injury, blood loss
occurred in 2 (1%) and 2 (1%) cases respectively.
In our study, one case of biliary injury occurred in RS non visible in
the form of CBD injury diagnosed intraoperative and managed by
hepaticojejunostomy after conversion to open. One case of biliary
injury occurred in RS visible in the form of bile leak from cystic duct
stump, the dissection was at the level of RS, diagnosed postoperative
and managed by ERCP with stent.
The RS was not found in the 2 cases of blood loss.
The present study showed that, regarding postoperative data in the
study participants, collection was present in 5 (3%) participants and
biliary leak in 2 (1%) participants. Postoperative wound infection
occurred in 4 (2%) participants and drain was present in 148 (95%)
participants.
In 46(30%) cases the dissection was done at level of Rouviere’s
sulcus 1 case of biliary leak from cystic duct stump , 2 cases postoperative
collection.
In all cases, only 4 (2%) were converted to open cholecystectomy in
the form of technical problem (1 cases). Severe adhesion and
inflammation (1 cases).distorted anatomy (1 cases) and biliary injury
(1case).
Duration of operation and length of hospital stay was significantly
longer in patients whom RS were not visible than those who were
visible (p <0.001, =0.008 respectively).