Non-oncologic pancreatic surgery in uremic patients presents unique challenges due to their increased susceptibility to complications and mortality. This chapter highlights the complexities of managing these high-risk patients, focusing on preoperative, perioperative, and postoperative strategies. Preoperative care involves optimizing cardiovascular and renal function, correcting anemia, and stabilizing electrolyte imbalances. Perioperative considerations emphasize fluid management, adjusted anesthetics, and careful monitoring of coagulation. Postoperative care prioritizes infection control, appropriate analgesia, and dialysis adjustments. Surgical indications include managing complications from chronic pancreatitis, such as pseudocysts and bile duct obstruction, or severe acute pancreatitis requiring intervention. The preference for minimally invasive procedures, like endoscopic or laparoscopic drainage, reduces systemic risks. Evidence indicates higher morbidity and mortality rates for uremic patients compared to non-uremic cohorts, primarily due to infection, delayed diagnosis, and inadequate dialysis. Multidisciplinary collaboration between nephrologists, surgeons, and anesthesiologists is essential for optimal outcomes. Emerging techniques, such as robotic surgery and advanced endoscopic modalities, promise better precision and shorter recovery times. However, despite progress, limited data on this patient group underscores the need for further research. Future studies should focus on improving evidence-based approaches to minimize complications and enhance surgical outcomes in this vulnerable population.