Background <p>Surgical site infections (SSIs) are a significant cause of morbidity in colorectal surgeries, mainly due to the contaminated nature of these procedures. Traditional wound management techniques have limitations, leading to prolonged hospital stays and increased healthcare costs. Negative pressure wound therapy (NPWT) has emerged as an advanced method for managing surgical wounds, promoting faster healing by enhancing tissue perfusion, reducing edema, and managing wound exudate. This retrospective cohort study aims to compare the outcomes of NPWT with those of conventional wound care in patients undergoing high-risk gastrointestinal surgeries.</p> Methods <p>A total of 141 patients classified as having contaminated or dirty wounds were divided into two groups: the NPWT group (47 patients) and the conventional wound care group (94 patients). Postoperative outcomes, including SSIs, wound healing, dehiscence, and incisional hernia development, were monitored at 1 month and 1 year.</p> Results <p>The results revealed a significant reduction in superficial SSIs in the NPWT group (6.4% vs. 18.1%, <i>p</i> = 0.04), along with shorter hospital stays (8.9 vs. 11.2 days, <i>p</i> = 0.01). Incisional hernia rates were also significantly lower in the NPWT group at both 1 month (6.4% vs. 12.8%, <i>p</i> = 0.05) and 1 year (6.4% vs. 16.0%, <i>p</i> = 0.03). While the reduction in deep SSIs did not reach statistical significance (2.1% vs. 9.6%, <i>p</i> = 0.08), the observed trend suggests further investigation.</p> Conclusion <p>This study demonstrated that NPWT not only reduces the incidence of SSIs and hospital stays but also decreases the long-term incidence of incisional hernias. These findings suggest that NPWT should be considered a standard approach for managing high-risk surgical wounds, especially in gastrointestinal procedures, where infection risks are inherently greater.</p>