Background <p>This study aims to evaluate the feasibility and safety of two intestinal fecal diversion methods using novel stents to prevent anastomotic leakage after surgery for middle and lower rectal cancer, and to compare their advantages and disadvantages for clinical application.</p> Methods <p>A retrospective analysis was conducted on 101 patients who underwent laparoscopic radical resection(LAR) for rectal cancer at Yongchuan Hospital from June 2021 to March 2024. Patients were divided into three groups: 26 in the ileum group (using terminal ileal stents) ,54 in the in situ group (using rectal in situ covered stents) and 21 in the control group. Preoperative, surgical, and postoperative data were compared among the three groups.</p> Results <p>No significant differences were found in baseline characteristics, surgical data, or the occurrence of postoperative anastomotic leakage or other complications. The in situ group showed no statistically significant differences from the control group in the postoperative hospital stay(12.6 ± 3.7 vs. 11.4 ± 2.9days, <i>p</i> &gt; 0.05 ), total cost of hospitalization (48903.58 ± 7094.14 vs. 82205.77 ± 12222.41yuan, <i>p</i> &gt; 0.05). Moreover, the ileum group in these comparisons performed worse than the control group. After incorporating data related to stoma closure surgery, the in situ group and ileum group showed significant advantages in overall hospitalization costs(59085.88 ± 7460.79 vs. 48903.58 ± 7094.14 vs. 81418.32 ± 11186.78yuan, <i>p</i> &lt; 0.05), and the in-situ group also had shorter overall hospital stay(17.6 ± 5.0 vs. 22.2 ± 4.0days, <i>p</i> &lt; 0.05).</p> Conclusions <p>Both fecal diversion methods showed acceptable rates of postoperative anastomotic leakage and can avoid a second stoma closure surgery. The in situ covered stent method seemed better as it not only saved hospitalization time and costs but also made postoperative management simpler and more efficient.</p>