With the in-depth understanding of local pelvic anatomy and the development of laparoscopic double anastomosis technique, total rectal mesenteric excision (TME) has gradually become the standard procedure for middle and lower rectal cancer. However, the problem of anastomotic blood supply after TME, together with the fact that many patients received neoadjuvant radiotherapy before surgery, has made it easy to develop anastomotic fistula after TME for low rectal cancer, and it has become the most important complication after radical surgery for low rectal cancer. The literature reports that the incidence of anastomotic fistula after rectal cancer surgery is 2.8% to 11.0%. Some scholars believe that anastomotic fistula is not directly related to prophylactic stoma, and that prophylactic stoma does not reduce the incidence of postoperative anastomotic fistula, and that prophylactic stoma may lead to stoma-related complications, requiring secondary surgery to retract the stoma and increasing hospitalization costs, which is overtreatment. Another part of scholars argues that anastomotic fistula is directly related to prophylactic stoma, and that a surgeon performing surgery for low to intermediate rectal cancer will use prophylactic stoma in patients he considers to be at high risk for anastomotic fistula, while not performing prophylactic stoma in patients who are less likely to develop anastomotic fistula, making it appear that patients with prophylactic stoma are objectively more likely to develop anastomotic fistula. The results of a rigorously designed randomized, prospective, controlled study are essential to evaluate the relationship between the two.Matthiessen et al. conducted an RCT on the relationship between anastomotic fistula and prophylactic stoma in low rectal cancer surgery and showed that the incidence of anastomotic fistula was 10.3% in the stoma group (116 patients) and 28.0% in the non-stoma group (118 patients) and the reoperation rate was significantly higher in the non-stomy group than in the stoma group. Chude et al. randomized 256 patients who underwent low anterior rectal resection with the anastomosis less than 5 cm from the anal verge into the stoma and non-stoma groups according to whether they had prophylactic small bowel collaterals or not, and the incidence of anastomotic fistula was 2.2% and 10.0% in the two groups, respectively. All of the above studies strongly recommend routine prophylactic stoma in low and ultra-low rectal preoperative resection. The relationship between prophylactic stoma and postoperative anastomotic fistula in low-grade rectal cancer has also been summarized in three recent years, and the results also support the routine use of prophylactic stoma in low-grade anterior resection for rectal cancer. Prophylactic stomas can be divided into colostomies and ileostomies. Compared with colostomy, ileostomy has the advantages of less susceptibility to infection, easier care, better blood supply and easier healing of small bowel anastomosis after reduction, so ileostomy should be preferred. The clinical practice of our center for many years shows that terminal ileostomy has the following advantages: (1) basically complete diversion, which can achieve the purpose of prophylactic stoma; (2) the distal stoma is open, which is convenient for intestinal preparation before the return operation; (3) the small intestine is rich in blood supply, and the stoma heals quickly after the return operation, which is less likely to occur small intestinal anastomotic fistula; (4) the terminal ileostomy double-lumen return operation does not need to search for the distal intestine, and the operation is shorter, less bleeding and less traumatic. (4) The double-lumen stoma of the terminal ileum is not necessary to find the distal intestine, and the operation time is short, bleeding is small and trauma is small. Therefore, in our clinical practice, we use a double-lumen terminal ileostomy 20 cm from the ileocecal region.