Training in Emergency Surgery.

Although emergency surgery accounts for 50% of the surgery cases in hospitals in Italy, in 57% of the hospitals emergency surgery is not performed by a dedicated team. In Europe, numerous surveys have shown that 50% of the young surgeons desire a more complete training in emergency general surgery (EGS). A survey conducted by the Association of Surgeons in training in the UK has shown that trainees want greater competence in EGS (92.4%) through the adoption of specific programs and training protocols. The Italian Society of Emergency Surgery and Trauma (SICUT)) has decided to try to make up for this lack of training by organizing specific courses that can serve as a training pathway in EGS. KEY WORDS: Emergency Surgery, Training.

A systematic review on the use of topical hemostats in trauma and emergency surgery.

BACKGROUND: A wide variety of hemostats are available as adjunctive measures to improve hemostasis during surgical procedures if residual bleeding persists despite correct application of conventional methods for hemorrhage control. Some are considered active agents, since they contain fibrinogen and thrombin and actively participate at the end of the coagulation cascade to form a fibrin clot, whereas others to be effective require an intact coagulation system. The aim of this study is to provide an evidence-based approach to correctly select the available agents to help physicians to use the most appropriate hemostat according to the clinical setting, surgical problem and patient's coagulation status. METHODS: The literature from 2000 to 2016 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] protocol. Sixty-six articles were reviewed by a panel of experts to assign grade of recommendation (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system, and a national meeting was held. RESULTS: Fibrin adhesives, in liquid form (fibrin glues) or with stiff collagen fleece (fibrin patch) are effective in the presence of spontaneous or drug-induced coagulation disorders. Mechanical hemostats should be preferred in patients who have an intact coagulation system. Sealants are effective, irrespective of patient's coagulation status, to improve control of residual oozing. Hemostatic dressings represent a valuable option in case of external hemorrhage at junctional sites or when tourniquets are impractical or ineffective. CONCLUSIONS: Local hemostatic agents are dissimilar products with different indications. A knowledge of the properties of each single agent should be in the armamentarium of acute care surgeons in order to select the appropriate product in different clinical conditions.