The long-term results of 76 Kock continent ileostomy operations were evaluated at an average 9 years postoperatively. The early complication rate was 36%: 11 (14%) patients underwent reoperation including one (1.3%) pouch removal, and one patient died. Late complications occurred in 54 (73%) patients. These included two (2.7%) pouch-related deaths, 30 (41%) cases of nipple-valve sliding, 22 (30%) clinically observed cases of pouchitis, 12 (16%) patients with stomal strictures, and intestinal obstruction (7), ventral hernia (4), nipple-valve fistula (7), intra-abdominal abscess (4) and foreign body in the reservoir (7). Revisional surgery was required in 49 (66%) patients. Despite this high cumulative complication rate a good functional result was ultimately attained in 62 (83%) patients. Only four reservoirs were removed, and only three patients had to wear an appliance. Increasing experience with the method resulted in a marked decrease of both early and late complications. The high degree of patient satisfaction supports continuation of Kock ileostomy constructions even though prolonged follow-up and frequent reoperations may be required.