AIM: This study compared the clinical efficacy of preventive ileostomy supported by autologous flaps versus stents in laparoscopic radical resection of low rectal cancer. METHODS: Sixty-four patients diagnosed with low rectal cancer who underwent laparoscopic radical resection in Fuyang Women's and Children's Hospital between April 2020 and December 2023 were included in this study. Based on the intraoperative support method, the patients were divided into a control group (n = 30) receiving stent support and a flap support group (n = 34) undergoing autologous flap support. Surgical outcomes, perioperative indicators, and postoperative complications were analyzed and compared between the groups. Patients were followed up for six months to evaluate recovery outcomes. RESULTS: Significant differences were observed in operative time, total duration of surgery, intraoperative blood loss, and hospitalization costs between the two groups (p < 0.05). Postoperative levels of inflammatory markers, including C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT), were elevated at 2, 4, and 6 days after surgery in both groups, while erythrocyte sedimentation rate (ESR) and prealbumin (PA) levels decreased in both groups compared to preoperative levels (p < 0.05). Notably, the flap support group demonstrated significantly lower CRP, IL-6, PCT, and ESR levels and higher PA levels at the same time points compared to the control group at 2, 4, and 6 days after surgery (p < 0.05). The complication rate in the flap support group (2.94%) was significantly lower than in the control group (20.00%) (p < 0.05). During the follow-up period, no cases of permanent fistula were observed in the flap support group, while the control group reported a 13.33% incidence of permanent fistula, indicating a statistically significant difference between the two groups (p < 0.05). CONCLUSIONS: Preventive ileostomy supported by autologous skin flaps offers advantages in laparoscopic radical resection for low rectal cancer. This approach simplifies the procedure, eliminates the need for secondary stent removal, reduces postoperative complications, and improves overall safety and recovery outcomes.