Objective: To compare the advantages and disadvantages of double-barrel terminal ileostomy and double-barrel transverse colostomy for temporary fecal diversion after anus-preserving surgery for rectal cancer. Methods: The clinical data of patients undergoing anus-preserving surgery for rectal cancer at our hospital were retrospectively analyzed. For temporary fecal diversion, 54 cases underwent double-barrel terminal ileostomy and 32 cases underwent double-barrel transverse colostomy. The general medical data and complications related to stoma and stoma closure of the patients between the two groups were compared. Results: No significant difference was noted between the two groups in terms of incidence of anastomotic leakage (P>0.05). The incidence of stoma-related complications of the double-barrel terminal ileostomy group (10.9%) was significantly lower than that of the double-barrel transverse colostomy group (37.5%) (P<0.05). The incidence of complications related to stoma closure of the double-barrel terminal ileostomy group (10.0%) was significantly lower than that of the double-barrel transverse colostomy group (32.0%) (P<0.05). Conclusions: Double-barrel terminal ileostomy is recommended to divert the fecal stream for those high-risk patients following anus-preserving surgery for rectal cancer.