Background <p>Following the establishment of the hybrid diagnosis-related groups (DRG) in the German healthcare system, the questions of feasibility and practicability arise.</p> <p>The available methods regarding surgical treatment of hemorrhoids vary considerably in terms of indications, potential complications, costs as well as operator and infrastructure requirements.</p> Objective <p>The aim of this study is to analyze the current situation, feasibility and challenges of outpatient proctological surgery for hemorrhoidal disease in Germany.</p> Material and methods <p>Review and analysis of the currently available literature.</p> <p>Detailed comparison of established surgical procedures for the treatment of hemorrhoids. Evaluation of the operative treatment options with respect to outpatient feasibility, taking medical and economic factors into account.</p> <p>Evidence-based discussion of basic research.</p> Results <p>Taking diagnosis-adapted, patient-specific, structural and economic aspects into account, only the Barron rubber band ligation and the Milligan-Morgan, Parks and Ferguson resection procedures are fully applicable on an outpatient basis. Reconstructive procedures according to Fansler-Arnold, Longo hemorrhoidoplasty as well as laser hemorrhoidoplasty and radiofrequency ablation are not suitable for use in the outpatient sector under the current conditions of the German healthcare system.</p> Conclusion <p>Outpatient proctological surgery is only effective if it is designed to be medically, qualitatively and economically viable. A&#xa0;pure cost-cutting measure without careful patient selection and appropriate reimbursement leads to a&#xa0;quality deficit and jeopardizes safe patient care.</p>