Purpose Laparoscopic colorectal procedures require specimen extraction. Our centre’s colorectal surgeons employ midline and off-midline incisions for extraction of surgical specimens. Midline incision for specimen extraction is associated with higher incidence of both surgical site infection (SSI) and Incisional hernia (IH). We sought to assess compare outcomes in off-midline versus midline extraction sites for colorectal resections. Methodology This was a retrospective, single institution, multi-surgeon study for patients undergoing laparoscopic colorectal resection for both malignant and benign pathology from January 2021 to January 2024. Datapoints extracted include patient demographics; risk factors for SSI and IH and operative details. Any cases which were converted to open, returns to theatre or used perineal extraction were excluded. Between extraction site techniques, primary outcome measures being development of SSI or acute dehiscence within 30 days of surgery and development of IH within 12 months of the surgery were examined. Nominal data was compared using the Student’s t-test (parametric) and Wilcoxon test (nonparametric). Ordinal data was compared using the Man-Whitney U test. Non-ordinal categorical data was compared using Pearson’s chi-squared test. Statistical significance was defined as p < 0.05. Results A total of 231(196 elective) were examined. Median age was 67 50% were female, 27% received chemotherapy. Common indications for surgery included colorectal cancer (117) and diverticular disease (76). Extraction techniques included midline (41.5%); left lower quadrant (10.8%) and Pfannenstiel (47.6%). There was a lower SSI incidence in Pfannenstiel compared to midline extraction (2.7% vs 4.1%). There was no incidence of acute dehiscence. There were no IH at 12 months in off-midline, compared to 6 (6.3%) from midline extraction. Survival was similar between cohorts. Conclusion Our preliminary results suggest that off-midline extraction sites have less risk of incisional hernia incidence at 12 months and lower SSI rate.