Objective To investigate the safety and clinical effect of prophylactic ileostomy using right lower abdominal specimen extraction incision in laparoscopic rectal low anterior resection and its impact on ileostomy closure. Methods A retrospective analysis was conducted on 127 patients who underwent laparoscopic low anterior resection of rectal cancer combined with prophylactic ileostomy in Department of General Surgery in our hospital from January 2020 to December 2023. Patients were divided into observation group （n = 60） and control group （n = 67） based on whether with prophylactic ileostomy using the right lower abdominal specimen extraction incision or not. Relevant data and clinical data of ileostomy closure were compared between the two groups. Results （1）There was no significant difference in baseline clinical data between the two groups （P > 0.05）. （2）In terms of operation time， pain score within three days after surgery and postoperative first exhaust time， the observation group was better than the control group， showing statistical difference （P < 0.05）. In the observation group， the average length of the incision was longer than that in the control group， and it was significantly different between the two groups （P < 0.05）. There was no significant difference between the two groups in terms of blood loss， postoperative feeding time and postoperative hospital stay （P > 0.05）. （3） There was no significant difference between the two groups in postoperative and ostomy-related complication S （P > 0.05）. （4） The observation group was better than the control group in terms of postoperative pain score and postoperative first exhaust time， indicating statistical significance （P < 0.05）. There were no significant differences in surgical time， abdominal adhesion， blood loss， postoperative hospital stay and postoperative complications between the two groups （P > 0.05）. Conclusion The patients undergoing laparoscopic rectal low anterior resection who needs prophylactic ileostomy using right lower abdominal specimen extraction incision can improve the appearance of the incision， shorten operation time， reduce postoperative pain of the patients but does not increase postoperative complications and the difficulty of ileostomy closure. It is safe and feasible， which worthy for clinical promotion.