Background Early vascular complications following pancreatic transplantation are not uncommon (3%–8%). Typically, cross‐sectional imaging is requested in response to clinical change. We instituted a change in protocol to request imaging pre‐emptively to identify patients with thrombotic complications. Methods In 2013, protocol computer tomography angiography (CTA) at days 3–5 and day 10 following pancreas transplantation was introduced. A retrospective analysis of all pancreas transplants performed at our institution from January 2001 to May 2019 was undertaken. Results A total of 115 patients received pancreas transplants during this time period. A total of 78 received pancreas transplant without routine CTA and 37 patients with the new protocol. Following the change in protocol, we detected a high number of subclinical thromboses (41.7%). There was a significant decrease in invasive intervention for thrombosis (78.6% before vs 30.8% after, p = .02), and graft survival was significantly higher (61.5% before vs 86.1% after, p = .04). There was also a significant reduction in the number of graft failures (all‐cause) where thrombosis was present (23.4% before vs 5.6% after, p = .02). Patient survival was unaffected (p = .48). Conclusions Implementation of early protocol CTA identifies a large number of patients with subclinical graft thromboses that are more amenable to conservative management and significantly reduces the requirement for invasive intervention.

Pulsatile tinnitus resulting from an abnormal communication between the occipital artery and the transverse or lateral sinus is a rare clinical entity. We report three cases which presented over a period of three years who had such abnormalities demonstrated angiographically and were cured of their symptoms by exploration and ligation of the occipital artery.

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Introduction Laparoscopic Nissen fundoplication remains a key option for surgical treatment of refractory gastro-oesophageal reflux disease. However, limited long term data are available on postoperative symptoms and satisfaction. We aimed to evaluate these in our patients 10 years following their operation. Methods 144 patients were contacted by telephone. Participants were asked about heartburn and obstructive symptoms. If heartburn or dysphagia was present they scored this on a scale of 1–5. Satisfaction was scored from 0–5 and using a four point outcome scale. Respondents were also asked whether they would recommend the operation or have a reoperation if needed. Results We gained 49 participants with operation dates from 2009–2011. 5 participants had since had a redo operation so were excluded from the symptom analysis. There was a high prevalence of obstructive symptoms in the respondents, and a significant minority still experience a degree of heartburn. Conclusion Satisfaction with Nissen fundoplication remains high for most patients 10 years post-operation. However, there remains a significant obstructive symptom burden. This is important to consider as alternative procedures such as Toupet fundoplication become more prevalent.