This chapter provides key concepts and terminology related to the surgical management of operative abdominal trauma. Indications for trauma laparotomy are given. A step-wise systematic approach to the trauma laparotomy is provided with emphasis on control of bleeding, contamination, and the decision for definitive repair versus damage control. Surgical mobilizations and maneuvers used in the setting of various injuries are discussed. The role of laparoscopic surgery in abdominal trauma is outlined.