Ileostomy is widely used in sphincter-preserving surgery for low rectal cancer. It can serve not only as a temporary protective measure for low rectal anastomosis surgery, but also as a permanent treatment. In recent years, advances in laparoscopic technology (Da Vinci robot/3D) and the concept of mesenteric anatomy have significantly increased the sphincter-preserving rate for low and ultra-low rectal cancer; however, the incidence of anastomotic leakage has not decreased. To prevent the occurrence of leakage after low rectal anastomosis and reduce the severity of complications caused by anastomotic leakage, prophylactic ileostomy is clinically performed during the surgical procedure. Despite continuous improvements in surgical techniques and stoma care, short-term and long-term complications associated with ileostomy, as well as the resulting psychosocial barriers, remain common. Therefore, we need to take effective measures during the perioperative period to reduce the risk and severity of stoma-related complications. For complications that have already occurred, we should actively adopt effective treatment measures, strengthen technical guidance and psychological counseling for stoma patients, and ultimately improve the patients’ prognosis and postoperative quality of life.