Umbilical hernia develops in 20% of patients with cirrhotic ascites due to raised intra-abdominal pressure. Complications like obstruction and strangulation though rare, can pose a serious challenge. The management of these patients has been a subject of debate. Earlier, surgery was advocated only for those patients with complicated umbilical hernia. The rest were managed conservatively. This led to higher morbidity and mortality. At present, it is advocated to operate every case. For those eligible for liver transplantation, hernia repair is done at the time of transplantation and for those not eligible for liver transplantation, hernia repair is done after control of ascites. If ascitic fluid is not infected, mesh repair is increasingly being favoured under antibiotic cover. Laparoscopic repair is gaining popularity these days and has been done successfully in selected complicated cases as well.
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