Background: Prosthetic mesh reinforcement of abdominal wall hernias has gained acceptance as a result of its ease of placement and a favorably low incidence of hernia recurrence. Objective: To evaluate the outcome of complicated umbilical hernial repair after herniorrhaphy or hernioplasty in patients with advanced cirrhosis and refractory ascites regarding postoperative morbidity and mortality. Patients and methods: This study was a prospective randomized controlled study designed for cirrhotic cases presented with complicated umbilical hernia. It was conducted during the period between January 2019 and January 2020 at Al-Azhar University Hospitals. The study included a total of who were randomly divided into two equal groups; Group A 20 cases who underwent herniorrhaphy, and Group B 20 cases who underwent hernioplasty. Results: CTP class B was present in 65 and 70% of cases in both groups respectively, while the remaining cases had class C disease. CBC, liver function, and renal function parameters were not significantly different between the two groups, apart from platelet count, that was significantly higher in group B. The degree of ascites did not significantly differ between the two groups, and ascites was present in all of the included cases. Obstruction was the commonest complication encountered as it was present in 40% of cases in both groups. Other causes included strangulation, leaking hernia, and irreducibility. The type of complication did not significantly differ between the two groups. Resection anastomosis of a part of the small intestine was performed in 25 and 20% of cases in both groups respectively. Operative time was significantly longer in group B. Hospital stay was not significantly different between the two groups. The incidence of morbidity and mortality did not significantly differ between the two groups. Recurrence was significantly higher in group A. Conclusion: The use of a prosthetic mesh in complicated cases showed an advantage over the conventional techniques as it was associated with lower recurrence rates with no difference in post-operative morbidity and mortality compared to herniorrhaphy.