Intestinal failure remains a major cause of morbidity and mortality in children. Intestinal transplantation has emerged as a life-saving therapy for selected patients and is now a routine therapeutic tool at some transplant centers. The short-term and long-term survival rates after intestinal transplantation have steadily increased. The complications associated with intestinal transplantation continue to be rejection, infections, and perforations. The technical aspects of the operation have been refined and standardized. New immunosuppressive agents and experience in treating these very ill children have reduced complications and improved survival. This review focuses on patient selection, the surgical techniques for both isolated small bowel and combined liver and small bowel transplantation, postoperative management, and the results achieved to date.