This paper reviews the development of the Kock procedure for continent ileostomy. Several problems are encountered in this procedure; primarily relating to 1) construction of the ileal reservoir and 2) construction of the “valve” or continence mechanism. Alternative approaches to each of these areas are compared. Techniques for creation of the ileal reservoir have improved to the stage where advances come slowly. In the area of the continence mechanism, numerous alternatives continue to be evaluated. In general, the procedure is evolving. The use of biomaterials to reinforce the “valve” is on the rise. Advantages and disadvantages of alternative technological approaches are compared.