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. 2026 Feb 6;5:16018. doi: 10.3389/jaws.2026.16018

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Copyright © 2026 Niebuhr, Woeste, Winkler, Behle, Reinpold, Dag and Köckerling.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Flowchart depicting a surgical treatment protocol for hernias. It starts with prehabilitation and botulinum toxin A injection four weeks prior, followed by peritoneal flap preparation. Based on hernia width, different paths include sublay mesh augmentation, fascial closure, TAR/endoscopic ACS, IFT, and overlapping sublay mesh augmentation. A note clarifies TAR and endoscopic ACS preferences. — The Hamburg algorithm 2.0 for complex abdominal wall repair. IFT, Intraoperative Fascial Traction; TAR, Transversus Abdominis Muscle Release; ACS, Anterior Component Separation.