The purpose of this study was to determine the prevalence and to
investigate the morphology of the sulcus of the caudate process in a
Greek population, along with a systematic review and meta-analysis of
the literature. Overall, 103 consecutive patients undergoing
laparoscopic cholecystectomy were included in the analysis. The sulcus
was present in 91% and three morphological variants were identified
(groove 69%, slit 21% and scar 10%). The sulcus had a horizontal
course in 90% of patients and a mean length of 25 +/- 13 mm. The
meta-analysis included 27 surgical and 11 cadaveric studies with 6661
cases in total. The pooled prevalence of the sulcus was 80% and did not
differ significantly among various geographical regions. Concerning
sulcus subtypes, the binary “open/fused” classification was used to
unify the heterogeneous data. The “open” type was more frequent than
the “fused” (64.5% vs 35.5%). A horizontal course was observed in
53.5% and an oblique in 45.7%. The sulcus contained the right portal
pedicle in 38%, the right posterior portal pedicle in 37%, and the
right posteroinferior pedicle in 23.5%. In conclusion, the sulcus of
the caudate process is a very helpful anatomical landmark in hepatectomy
and laparoscopic cholecystectomy and can be identified in the majority
of patients. However, various classifications for the morphological
variants and diverse terminology cause discrepancy in the literature and
create the need for a single classification system. The proposed 3-tier
classification (groove, slit, scar) is simple and easy to remember and
avoids ambiguous nomenclature