Background: Cognitive impairment is common, debilitating, and poorly managed in persons with multiple sclerosis (pwMS). Exercise training might have positive effects on cognitive performance in pwMS, yet the overall magnitude, heterogeneity, and potential moderators remain unclear. Objective: This three-level meta-analysis aims to identify the effects of exercise training and those of exercise modalities on global and domain-specific cognitive performance in pwMS. Methods: MEDLINE, PsycInfo, SportDiscus, CENTRAL, and EMBASE were screened for randomized and non-randomized clinical trials from inception to 27 January 2020, yielding 3091 articles. Based on titles and abstracts, 75 articles remained in the selection process. After full-text evaluation, 13 studies were finally selected (PROSPERO pre-registered). Results: The pooled effect of exercise training on the global cognitive performance was null ( g = 0.04, 95% confidence interval (CI): –0.11 to 0.18) and no significant differences were displayed among domains. Heterogeneity within studies was null ([ ]= 0.0%) and between studies was low ([ ]= 25.1%). None of the moderators (exercise modalities, age, Expanded Disability Status Scale (EDSS), supervision, cognitive domains) reached significance. However, the exercise volume explained most of the overall heterogeneity (slope = 4.651 × 10⁻⁵, [ ] = 100%, [ ] = 52.34%). Conclusion: These results do not support the efficacy of exercise training on global or domain-specific cognitive performance in pwMS. Future studies are needed to determine whether higher training dose are beneficial.

Background/Objectives: Minimally invasive approaches are increasingly used in right colectomy for colon cancer; however, comparative data, including open, laparoscopic, and robotic techniques, remain limited, particularly regarding postoperative recovery and oncological outcomes. Methods: This retrospective monocentric study included 89 patients undergoing elective right colectomy for colon cancer between July 2018 and December 2022. Of these, 30 patients underwent open, 29 laparoscopic, and 30 robotic-assisted surgery. The primary endpoint was postoperative recovery, defined as the time to first bowel movement. Secondary endpoints included length of hospital stay, complete mesocolic excision (CME) quality, lymph node yield, C-reactive protein (CRP) on postoperative day one, operative time, overall survival (OS), and disease-free survival (DFS). Multivariable regression analyses were performed adjusting for age, sex, BMI, ASA score, UICC stage, and tumor size. Results: Time to first bowel movement was shorter after minimally invasive surgery (median robotic 3.5, laparoscopic 4 vs. open 5 days) and length of hospital stay was numerically shorter (mean 9.1 vs. 10.1 days). CME quality and lymph node yield did not differ significantly between the approaches, and postoperative day-one CRP was numerically lower after robotic (median 4.9 mg/dL) and laparoscopic (5.1 mg/dL) than after open surgery (7.1 mg/dL), without reaching statistical significance after adjustment. Operative time was significantly longer with minimally invasive surgery (robotic +50 min; laparoscopic +43 min vs. open; both p < 0.001). Disease-free (open 51.6%, laparoscopic 66.5%, robotic 66.9%) and overall survival did not differ significantly after adjustment (robotic HR 1.16; laparoscopic HR 1.01 vs. open). Conclusions: No statistically significant difference in surgical quality between the approaches was detected, while operative time was significantly longer after minimally invasive surgery. No statistically significant independent association between the surgical approach and postoperative recovery or three-year oncological outcomes was detected; given the limited precision of the estimates, clinically important differences cannot be excluded.

Background/Objectives: Unplanned inpatient admission after intended outpatient surgery is commonly regarded as failure of ambulatory management, although the clinical relevance of such admissions remains unclear. This study evaluated the causes, management, and short-term outcomes of unplanned inpatient admission after intended outpatient total extraperitoneal (TEP) inguinal hernia repair. Methods: This retrospective single-center study included all patients requiring unplanned inpatient admission after intended outpatient unilateral TEP repair between January 2022 and May 2025. Admission triggers, perioperative management, Clavien–Dindo complication severity, length of stay, need for invasive intervention, and 30-day outcomes were analyzed descriptively. Results: Among 153 intended outpatient TEP procedures, 45 patients (29.4%) required unplanned inpatient admission. The most frequent trigger was suspected intraoperative bleeding requiring observation (29/45, 64.4%), followed by technical or anatomical factors (6/45, 13.3%), cardiovascular events (4/45, 8.9%), other medical reasons (3/45, 6.7%), postoperative pain or nausea (2/45, 4.4%), and social or organizational reasons (1/45, 2.2%). Thirty-seven patients (82.2%) had no postoperative complication, six (13.3%) had Clavien–Dindo grade I–II complications, and two (4.4%) had grade III or higher complications requiring invasive intervention. Most patients were discharged on postoperative day 1 (35/45, 77.8%). No patient required blood transfusion, intensive care admission, or 30-day readmission. Conclusions: Unplanned inpatient admission occurred in 29.4% of intended outpatient TEP procedures, representing a relatively high admission rate for a planned outpatient pathway. Although most admissions were associated with precautionary monitoring rather than clinically relevant morbidity, invasive intervention was required in a small proportion of patients. The retrospective data do not allow individual admissions to be classified as avoidable; however, the findings suggest potential for pathway optimization through more standardized discharge assessment and formalized admission criteria. Prospective studies are required to determine whether such standardization can reduce unplanned inpatient stays while maintaining patient safety.