Protective ileostomy is an important bridging procedure in low anterior resection for rectal cancer, aimed at preventing severe anastomotic complications. It has been shown to significantly reduce the risk of pelvic infections resulting from anastomotic leakage. However, whether ileostomy plays a positive clinical role in preventing anastomotic leaks remains a subject of considerable debate. The procedure for creating a protective ileostomy is relatively simple and convenient, making it a commonly used approach in clinical practice. Nevertheless, as a traumatic surgical procedure, ileostomy itself may lead to a range of complications. Therefore, it is crucial to comprehensively understand the potential complications associated with ileostomy, develop optimized management strategies, and carefully select appropriate patients for preventive ileostomy, as these steps hold significant clinical value. This article provides a systematic review of the types, development, and application of preventive ileostomy, as well as the management and prevention strategies for common complications. The aim is to offer valuable guidance to clinical surgeons in optimizing stoma management and minimizing complications in rectal cancer sphincter-preserving surgery.