Background: The treatment of umbilical hernia in the setting of cirrhosis poses unique specific management problems due to pathophysiology of cirrhotic ascities. 
Purpose: Thirty cases of liver cirrhosis have been studied for the outcome of complicated umbilical hernia in the presence of ascites.
Methods: From November 2001 to October 2002, we received 30 cases of complicated umbilical hernias in patients suffering from liver cirrhosis with ascites. Twelve of these patients were classified as Child C while 18 of them were considered Child B. All the cases were subjected to surgical management under local anesthesia. 
Results: Six cases had ruptured umbilical hernia and they underwent closure in two layers after reduction of the contents. 
Twenty-four cases presented with irreducible hernia and upon exploration, 12 cases had gangrenous omentum that was 
resected and the other 12 cases had gangrenous intestinal loops where resection and anastomosis was carried out without drains. Out of 30 patients, 8 patients developed postoperative tense ascites that responded to medical treatment in 6 of them and 2 patients needed paracentesis. One patient of this series died on fourth postoperative day of liver failure while the rest of the patients had an uneventful postoperative course in a follow up period ranging from 3 to nine months. 
Conclusion: Complicated umbilical hernia can be managed safely in ascitic patients under local anesthesia.