Background: management of umbilical hernia in patients with liver cirrhosis remains controversial. The general surgical opinion is that umbilical hernia in patients with liver cirrhosis and ascites has high operative risks and high recurrence rates after elective repair. Conservative treatment, however, can also have severe complications resulting in emergency repair. In these patients such operations carry an even greater risk of complications than compared to elective operations. Objective: Aiming at comparing between conservative treatment and elective repair of umbilical hernia in patients with liver cirrhosis and ascites. Patients and Methods: a randomized prospective interventional study Our series was carried out on 40 consecutive patients at General Surgery department, Al-Azhar University hospital; Bab Elshaeria, Cairo, Egypt in the period from June 2017 till September 2018. The patients were divided into 20 patients (group A) undergo surgical repair and 20 patients (group B) undergo conservative treatment. Mean follow up was 6 months. Results: elective repair of umbilical hernia in patients with liver cirrhosis and ascites had fewer complications than conservative treatment. Conclusion: Our study showed that elective repair of umbilical hernia in cirrhotic and ascetic patients had less complication than conservative treatment.