Patient Question I’ve been on peritoneal dialysis for eight months for my uremia, and I feel pretty good, but in the past two months I’ve discovered an inguinal hernia? Why did I get an inguinal hernia after dialysis? I heard that the hernia needs to be treated with surgery, but I have uremia and have to stick to dialysis, can I still have surgery? Doctor’s Answer Hernia is a common condition in uremic patients undergoing peritoneal dialysis, with an incidence of more than 10%. The most common is an inguinal hernia, and umbilical hernias are also not uncommon. Patients with inguinal hernias are often already weak, and long-term dialysis inevitably leads to repeated increases in abdominal volume and intra-abdominal pressure, while uremic patients usually also have problems with protein and collagen metabolism, so the incidence of hernias after peritoneal dialysis is much higher than that of the general population. The principle of treatment for hernia is surgery, which is the only effective means of curing hernia. Moreover, peritoneal dialysis patients are unlikely to have their dialysis terminated unless they receive a kidney transplant. If surgery is not performed in time, it will inevitably lead to rapid enlargement of the hernia, and eventually the patient will be forced to switch to hemodialysis, and the consequences of not being able to maintain peritoneal dialysis for patients who have contraindications to hemodialysis and do not have a timely source of kidneys will be catastrophic. Therefore, once the diagnosis of hernia is clear, surgery should be performed in a timely manner to relieve the worries of peritoneal dialysis. Since surgery is necessary, the next question to be answered is whether it can be done? What are the risks of surgery? Which type of surgery to use? And how to solve the problems of uremia and systemic conditions before and after surgery? Indeed, patients with uremia have multiple problems with body functions, not only with the elimination of metabolic toxins, but also with systemic nutritional status, protein metabolism, coagulation function, and decreased immunity, among others. Hernia surgery, especially inguinal hernia surgery, even though it is only a minor surgery, still carries many times more surgical risks for uremic patients who need to live on dialysis. These include easy bleeding during and after surgery, reduced tissue healing ability, poor resistance to infection, etc., while dialysis must be resumed within two days after surgery at the latest. However, as long as we do a good job of perioperative management, including adjusting the patient’s general condition, protein level, coagulation function, etc., the vast majority of patients are still able to tolerate inguinal hernia surgery. Dealing with postoperative dialysis remains the core of management. Depending on the patient’s specific situation, we can decide whether to switch the patient to temporary hemodialysis for 3-4 weeks to gain basic healing time for the hernia surgery wound; or to switch to low-volume, intermittent peritoneal dialysis in the prone position postoperatively to avoid surgical complications. In terms of choice of surgical approach, because of the presence of peritoneal dialysis, or open surgery to avoid interference with the abdominal cavity and peritoneal dialysis tubes, this time for the patient to do laparoscopic surgery is not suitable. For anesthesia we also have to decide whether to use laryngeal mask general anesthesia, hemihypophyseal anesthesia or local anesthesia according to the patient’s general condition, coagulation function and spinal condition. The general principle is that hernia surgeons and nephrologists work together to minimize the surgical risks and the probability of postoperative complications. Therefore, once a patient on peritoneal dialysis has a hernia, it must still be treated correctly and in a timely manner, and we believe that the doctors will be able to solve the hernia problem in a safe manner.