Continent ileostomy was described by Nils Kock in 1969 as an alternative to conventional ileostomy. The technique has evolved considerably over the past 50 years. Adoption of the continent ileostomy was slow due to the complexity of the operation, high complication rates, and frequent need for reoperation. Following the description of the restorative proctocolectomy for ulcerative colitis by Parks and Nicholls in 1978, use of the continent ileostomy has declined. Nevertheless, continent ileostomy still has a role in carefully selected patients. The operative details of S-pouch construction with nipple valve stabilization are presented.