Stapled hemorrhoidectomy or "hemorrhoidopexy" has gained popularity for the treatment of grade 3-4 hemorrhoids, largely due to decreased pain as compared to traditional surgical hemorrhoidectomy. This decreased pain, along with proven short term efficacy, has been supported by numerous randomized controlled trials. Despite this evidence in support of stapled hemorrhoidectomy, controversy exists due to rare but occasionally life threatening complications, and also due to significant chronic pain experienced by a small but significant subset of patients. Attention to the technical details of the operation will limit these deleterious outcomes, and allow stapled hemorrhoidectomy to maintain it's niche role in the treatment of symptomatic hemorrhoids.