Objective To evaluate the safety and advantages of modified Bacon one-time operation in laparoscopic radical resection of ultra-low rectal cancer.Methods The medical records of all patients who underwent laparoscopic modified Bacon procedure for ultra-low rectal cancer treated in Professor SONG Junmin Medical Group of our department from August 2018 to June 2020 were analyzed retrospectively. According to the different methods of intraoperative operation, the patients were divided into modified Bacon one-time operation (modified Bacon group, n=26) and Bacon secondary operation (traditional Bacon group, n=33). The perioperative period data and follow-up results were observed and compared.Results A total of 59 ptients were collected, including 26 cases in the modified Bacon group and 33 cases in the traditional Bacon group. There were no significant differences in gender composition, age, etc. baseline data between the two groups (P>0.05). All surgery were successfully completed. There were no conversion to laparotomy, intraoperative or postoperative massive bleeding, severe infection and other serious complications and perioperative period death. The incidence of anastomotic leakage in the modified Bacon group was lower than that of the traditional Bacon group ［0.0% (0/26) versus 18.2% (6/33), P=0.030］. There were no significant differences in the incidences of postoperative anastomotic bleeding, anastomotic stricture, rectal irritation, and external intestinal necrosis between the two groups (P>0.05). And the number of dissected lymph nodes, operation time, intraoperative blood loss, the first exhaust time, and postoperative hospital stay had no significant differences between the two groups (P>0.05). There were no significant differences in the severity degree and total score of low anterior rectectomy syndrome (LARS) between the two groups at 3 and 6 months after operation (P>0.05). However, the total LARS score at 6 months after operation was lower than that at 3 months in the same group (P<0.001). By the end of the last follow-up (January 2021), there was no obvious difference in the anal shape between the two kinds of surgery. There was no recurrence or death during the follow-up period.Conclusion Modified Bacon one-time operation for ultra-low rectal cancer is safe and feasible, which could achieve natural orififice specimen extraction surgery and ultra-low limit sphincter preservation, reduce occurrence of postoperative anastomotic leakage and external intestinal necrosis, times of operation, and shorten total length of stay and reduce total cost of hospitalization.