Complications following elective spay or neuter procedures are particularly feared by new graduates. However, even the most experienced surgeons may encounter surgical or postoperative complications. At best, complications associated with elective procedures can harm the doctor-client relationship. At worst, these can present legal and financial problems. Veterinary surgeons should be aware of the potential complications associated with elective sterilization, these should be communicated to the client, and there should be a clear plan for action when a complication occurs. This article reviews the reported complications encountered in elective sterilization surgery in companion animals, with a special focus on early detection and prevention.