This study analyzes circumstances triggering exclusion fouls and the effects of the extra-man offense, according to team and level differences between opponents, during the World Aquatics Championships-Fukuoka 2023. Eight hundred seventy exclusion fouls triggering 760 extra-man offense situations were analyzed using official date and released videos. Hypothesis testing for the differnces in the population proportions was examined by a chi-square test. Bonferroni correction was used for multiple comparisons. All differences were statistically significant at the 5 percent level. Regarding the exclusion fouls triggered in the center position by team, Serbia's number was higher than Japan's. Low-ranked teams playing against higher-ranked ones had significantly more fouls than did medium-ranked teams playing each other in direct free throw shots from further than six meters. Exclusion fouls were triggered by high-and medium-ranked teams, which had large-scale center forward players, and by low-ranked teams making direct free throw shots from further than six meters without being able to shoot from further within. Concerning the extra-man offense, according to team levels, high-and medium-ranked teams triggered more goals and penalty fouls than did low-ranked ones. Low-ranked teams had more incidents of misses and turnovers compared to medium-and high-ranked teams. Additionally, when looking at team levels, medium-ranked teams playing low-ranked ones had significantly more goals and penalty fouls than did low-ranked teams playing medium-ranked ones. Low-ranked teams must reduce the number of misses and turnovers to raise their shot success rate from less than 20% compared to higher-ranked ones in order to catch up with higher-ranked teams.