Anastomotic stricture of cholangiojejunostomy is not a common long-term postoperative complication after pancreaticoduodenectomy, whereas, it still bothers many pancreatic surgeons. For patients with the no-dilated common bile duct, how to prevent anastomotic stricture of cholangiojejunostomy after pancreaticoduodenectomy?
1- Usually hepaticojejunostomy is done using continuous anterior and posterior wall suture technique, in case of small CBD you can do posterior wall continuously and anterior wall interrupted or do both interrupted fashion.
2- you can use a small internal stent or pass a PTD pre-operatively and use it to stent the anastomosis.
In non dilated common duct I used the the same tecnique employed for cicatricial stenosis : I ligated the duct and perform a longitudinal anastomosis with continuous runnig suture and so far I did not have any stricture