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To conduct a systematic review on the incidence and aetiology of life-threatening septic complications following stapled hemorrhoidopexy, in order to optimise the care of patients treated with this technique.An extensive review of the English literature was performed, including meta-analyses,prospective trials, case reports, and letters to retrieve severe septic complications reported after stapled hemorrhoidopexy.Twenty articles reporting on 31 patients whopresented with severe septic complications after stapled hemorrhoidopexy were identified. Despiteprompt surgical treatment, five patients (16%) died. Factors that may be responsible for complications were the learning curve, misplacement of the purse string suture,presence of an undiagnosed enterocoele, bleeding from the staple line, rectal obliteration by the stapler, passage of air through the staple line, and entrapment of faecal material.Severe sepsis can occur after stapled haemorrhoidopexy. Surgeons who treat people with haemorrhoids should be aware of this rare complication, which may be lethal in up to16% of cases.