Background: Extralevator abdominoperineal excision (ELAPE) procedure leaves a large pelvic floor defect, and can result in a high rate of perineal hernia. Pelvic peritoneum reconstruction (PPR) could reduce the rate of perineal hernia. In this article, the authors reconstructed pelvic peritoneum by retracing running sutures with unidirectional barbed thread after laparoscopic ELAPE. The aim of the study is to evaluate the efficacy and safety of PPR by retracing running sutures with unidirectional barbed thread in laparoscopic ELAPE.Materials and Methods: Intact clinical data were collected retrospectively from 27 distal rectal cancer patients who underwent laparoscopic ELAPE. All the patients underwent PPR by retracing running sutures with unidirectional barbed thread in the operation. Pooled data of perineal-related complications were analyzed.Results: After retracing running sutures, the tension of pelvic peritoneum was enhanced. Of the 27 patients included, 2 patients had perineal dehiscence and 1 patient developed bowel obstruction. There were no instances of perineal hernia and pelvic peritoneal internal hernia.Conclusions: PPR by retracing running sutures with unidirectional barbed thread in laparoscopic can reduce the risk of perineal hernia.