The continent ileostomy (CI), originally described by Nils Kock, remains an important reconstructive option for selected patients requiring permanent fecal diversion but wish to avoid a conventional end ileostomy. Although ileal pouch–anal anastomosis (IPAA) has become the preferred restorative procedure following proctocolectomy, CI continues to play a relevant role both as a primary alternative in patients with contraindications to IPAA and as a salvage strategy after pouch failure. This narrative review summarizes the historical evolution, current indications, surgical technique, functional outcomes, complications, and quality-of-life implications of CI. Available evidence suggests that, despite relatively high rates of revisional surgery, long-term pouch survival and patient satisfaction remain favorable. Technical refinements — including the Barnett Continent Intestinal Reservoir (BCIR) and the T-pouch — have purportedly improved valve stability and durability. Conversion of a failed IPAA to CI represents an effective salvage approach, enabling patients to avoid a permanent end ileostomy while preserving small bowel length. Careful patient selection and management at specialized centers are essential to optimize outcomes. Far from obsolete, CI remains a valuable option within the contemporary colorectal surgical armamentarium.