Purpose To explore the influence of surgical technique on key outcomes in elective restorative colorectal surgery performed in a Victorian regional centre over a two-year period. Methods A retrospective analysis was performed on data collected on left and right elective restorative hemicolectomies undertaken at South West Healthcare. Exclusions included emergency, stoma and inflammatory bowel disease cases. Operations were stratified into laparoscopic intracorporeal anastomosis (LIA), laparoscopic extracorporeal anastomosis (LEA), and open extracorporeal anastomosis (OEA). LIA extraction sites were either mini Pfannenstiel, left iliac fossa (Gridiron) or transvaginal. LEA extraction sites were extended midline in all cases. These were correlated against the oral Morphine Equivalent Daily Dose (oMEDD) requirements, length of stay (LOS), return of mobility and post operative complications. Results Of the 48 eligible hemicolectomies, there were 19 LIA, 14 LEA and 15 OEA cases, listed from least to most invasive technique. The average total oMEDD requirements (38.8, 78.2, 355.7 mg), average LOS (3.8, 6.4, 9.9 days) and average day of first walk (day 1.3, 2.6, 3.3) all increased with the degree of invasiveness of technique. All intracorporeal anastomosis cases had better post operative outcomes than LEA and OEA cases: percentage of ileus (5.3, 14.3, 28.6 %), wound infection (0.0, 7.1, 6.7 %) and anastomotic leak (0.0, 0.0, 6.7 %). There was 1 death in the OEA group. Conclusion Less invasive approaches to surgery with intracorporeal anastomosis and smaller abdominal incisions showed strong correlations to improved post operative outcomes, reduced analgesia requirements and length of stay.