Rectal cancer surgery is moving from organ sacrificing abdominoperineal resection (APR) to organ-preserving anterior resection (AR). Neoadjuvant chemoradiation, low anterior resection and coloanal anastomosis play a major role in this context. Anastomotic leakage (AL) is the most feared complication of these procedures. Therefore, much importance is given to proximal diversions to protect anastomosis. This review has critically analysed the indications, various methods available, challenges, complications, benefits and patient selection for proximal diversions.