Purpose Anastomotic leakage was not rarely seen after low anterior resection, some cases went through a repeat operation while some not, the risk factors associated with second operation caused by anastomotic leakage remains elusive. The aim of this study is to identify the risk factors associated with repeat operation in patients with anastomotic leakage after low anterior resection. Methods Patients diagnosed with rectal cancer (less than 10cm apart from anus) and received low anterior resection in Fudan University Shanghai Cancer Center between January 2018 and July 2022 were retrospectively analyzed to investigate the relationship between anastomotic leakage and repeat operation. Results 1661 patients enrolled in this study. Patients with protective ileum stoma showed less probability to present with grade C anastomotic leakage ( P＜0.001), while patients received neoadjuvant therapy were more likely to occur anastomotic leakage( P=0.012). 52 patients occurred anastomotic leakage in total, 16 of them experienced a repeat operation, pelvic peritoneal reconstruction and protective ileum stoma were two protective factors in regard to repeat operation( P＜0.001 and P=0.012 respectively). Conclusion Pelvic peritoneal reconstruction is a feasible way to avoid protective stoma and repeat operation caused by anastomotic leakage, but it may not suitable for all potential grade C anastomotic leakage patients to avoid protective ileum stoma and repeat operation. Further studies were needed to define eligible patients for applying pelvic peritoneal reconstruction to avoid protective ileum stoma and repeat operation caused by potential grade C anastomotic leakage.