Guttural pouch diseases pose serious challenges in diagnosis and treatment. Complications from treatment are common and often life-threatening, largely because the unique anatomy of the guttural pouches brings them into intimate contact with the nervous, respiratory, and cardiovascular systems. There is little forgiveness for surgical errors, and so the surgeon should focus on ways to anticipate and prevent them. As with any disease, errors in diagnosis can set the stage for many surgical errors and must be recognized. This article deals with errors that can be expected after the most common surgical treatments for guttural pouch diseases.