Purpose To assess the impact of perineal closure modality on wound-related complications following abdominoperineal resection (APR) and completion proctectomy, and to evaluate associations between risk factors and short-term outcomes. Methods A retrospective cohort study of adults undergoing APR or completion proctectomy between June 2019 and June 2024 at a tertiary centre was performed. Primary exposures were perineal closure modality (primary suture closure, mesh reinforcement, or muscle flap). Primary outcomes were perineal surgical site infection (SSI) and wound dehiscence. Associations between risk factors and outcomes were analysed. Secondary analyses examined associations with other closure-related factors (dissection plane, primary vs secondary) and postoperative outcomes (including blood loss, length of stay). Results 47 patients were included; 36 (76.6%) underwent APR and 11 (23.4%) completion proctectomy. Majority were male (63.8%), obese (53.2%), had malignancy (70.2%) and radiotherapy (63.8%). Perineal SSI occurred in 9 patients (19.1%) and wound dehiscence in 20 (42.6%). Overall postoperative complications occurred in 61.7%. Primary closure modality was not associated with SSI, wound dehiscence, blood transfusion, or return to theatre. Secondary closure was a result of return to theatre and none of the primary closure modalities demonstrates a higher rate of return to theatre, however this result is limited by small numbers. High BMI was significantly associated with wound dehiscence (p = 0.018), as was male sex (p = 0.047). LOS did not differ significantly between patients with and without postoperative complications (p = 0.153). Conclusion In this study, perineal closure modality did not significantly influence wound-related outcomes following APR or completion proctectomy, whereas high BMI and male sex were associated with wound dehiscence. These findings suggest patient-related factors may be more influential than closure technique in short-term outcomes.