Laparoscopic appendectomy in children with perforated appendicitis

Purpose: There is persistent controversy regarding the optimal surgical therapy for children with appendicitis. We have recently adopted laparoscopic appendectomy in lieu of the open technique for children with perforated appendicitis. We hypothesized that laparoscopic appendectomy would be as effective as open appendectomy in preventing postoperative complications. Materials and Methods: We reviewed the medical records of children admitted to our hospital over a 5-year period with the diagnosis of perforated appendicitis. Patients were divided into two groups based on the operative approach: laparoscopic vs. open appendectomy. Demographic data, duration of presenting symptoms, initial white blood cell (WBC) count, length of stay, and complications were abstracted. Data were compared using appropriate statistical analyses. Results: There was no difference between the laparoscopic (n = 43) and open (n = 77) groups with respect to gender, duration of presenting symptoms, initial WBC, or length of stay. However, patients in the laparoscopic group had a significantly lower complication rate than those in the open group (6/43 vs. 23/77, P = 0.05). Infectious complications were no different between groups. Patients in the laparoscopic group tended to be older than patients in the open group (10.6 ± 3.3 years vs. 8.5 ± 4.1 years, P = 0.003). Conclusion: Laparoscopic appendectomy for children with perforated appendicitis has the same infectious complication rate and a lower overall complication rate than open appendectomy. A prospective study with standardized postoperative care would be needed to determine whether laparoscopic appendectomy for children with perforated appendicitis is the treatment of choice, but until then it remains an attractive alternative. © Mary Ann Liebert, Inc

Urban inequities; urban rights: a conceptual analysis and review of impacts on children, and policies to address them.

This paper explores current conceptual understanding of urban social, environmental, and health inequality and inequity, and looks at the impact of these processes on urban children and young people in the 21st century. This conceptual analysis was commissioned for a discussion paper for UNICEF's flagship publication: State of the World's Children 2012: Children in an Urban World. The aim of the paper is to examine evidence on the meaning of urban inequality and inequity for urban children and young people. It further looks at the controversial policies of targeting "vulnerable" young people, and policies to achieve the urban MDGs. Finally, the paper looks briefly at the potential of concepts such as environment justice and rights to change our understanding of urban inequality and inequity