Aim. To evaluate the feasibility, indications, and outcomes of laparoscopic surgery in hemodynamically stable combat casualties with abdominal trauma during the Ukrainian War of Independence.

Material and methods. A retrospective observational study included 238 hemodynamically stable patients with combat-related abdominal trauma treated at the Zaporizhzhia Military Hospital between 2022 and 2025. Medical records, operative protocols, imaging examinations (e-FAST, computed tomography), and intraoperative documentation were analyzed.

Results. Laparoscopic procedures performed included diagnostic laparoscopy (n = 78), foreign body removal (n = 60), hemostasis (n = 23), diaphragmatic repair (n = 19), hollow viscus suturing (n = 15), splenectomy (n = 5), and colectomy / colostomy (n = 12). Conversion to laparotomy was required in 28 cases (11.8 %), while secondary laparotomy was needed in 5 patients due to missed bowel injuries, intra-abdominal abscess, ileus, or bleeding. The best outcomes were achieved in American Association for the Surgery of Trauma (AAST) grade I–II injuries. Advanced bowel resections were technically complex requiring further validation for routine use. Barbed suture-based closure improved safety and efficiency in diaphragmatic and hollow viscus repair.

Conclusions. Laparoscopy appears to be a safe and effective option for selected hemodynamically stable patients with abdominal combat trauma. It reduces rates of unnecessary laparotomies, postoperative complications, and recovery time, facilitating faster return of soldiers to duty. Complex bowel resections require further validation before routine implementation in military trauma surgery.