Objective: To evaluate the clinical efficacy and safety of minimally invasive surgery (MIS) compared with open surgery in the treatment of severe abdominal surgical trauma. Methods: A retrospective cohort study was conducted involving 216 patients with grade III–V abdominal trauma admitted to our institution between January 2018 and December 2022. Patients were divided into the MIS group (n=102) and the open surgery group (n=114) based on the surgical approach adopted. Perioperative indicators, including operation time, intraoperative blood loss, length of hospital stay, and postoperative complication rates, were compared between the two groups. In addition, the 30-day mortality rate was analyzed as the primary outcome measure. Results: The MIS group exhibited significantly shorter operation time (125.6 ± 32.4 min vs. 168.3 ± 41.2 min, P<0.001), less intraoperative blood loss (350.2 ± 120.5 mL vs. 820.6 ± 210.8 mL, P<0.001), and shorter hospital stay (10.2 ± 3.1 days vs. 15.6 ± 4.3 days, P<0.001) than the open surgery group. The overall postoperative complication rate was lower in the MIS group (18.6% vs. 35.1%, P<0.01), with significant differences in the incidence of wound infection and abdominal adhesion. There was no statistically significant difference in the 30-day mortality rate between the two groups (6.9% vs. 8.8%, P>0.05). Conclusion: Minimally invasive surgery is a safe and effective approach for selected patients with severe abdominal surgical trauma, offering advantages such as reduced intraoperative trauma, faster postoperative recovery, and lower complication rates without increasing mortality risk.