External gastric fistulas have always been a complication of gastric surgery. Russia’s full-scale invasion of Ukraine has led to an increase in the number of wounded patients presenting with this pathology. The course and characteristics of this condition, namely, the severity and multifocality of the injuries, the duration and unfavorable results of previous treatment, the timing of the primary surgical intervention, and the extremely high resource intensity of the pathology, make this study relevant.

Aim: to analyze the experience of treating gunshot gastric fistulas using a multidisciplinary approach in the context of combat abdominal trauma.

Materials and methods. The experience of treating 111 patients with gunshot fistulas from 2022 to July 2025 is presented. A model of interaction between endoscopic and surgical methods targeting the external gastric defect, combined with optimal dual-probe intubation is shown.

Results. The proposed approach for treating external gunshot gastric fistulas, which includes the authors’ technique of gastric fistula myoplasty using a displaced rectus abdominis muscle flap combined with vacuum therapy, resulted in a complete cessation of fistula discharge through the drains one day after treatment in 86 (77 %) patients, as confirmed by fistulography. Nine (10 %) patients with multiple severe wounds and severe sepsis died.

Conclusions. To improve the treatment outcomes for gastric fistulas, the technique of gastric fistula myoplasty using a displaced rectus abdominis muscle flap in combination with transabdominal vacuum therapy and, in some cases, endoscopic vacuum therapy can be effectively utilized. The proposed approach for treating gunshot gastric fistulas is expected to improve the treatment outcomes for wounded servicemen of the Armed Forces of Ukraine.