Background: The policy of elective repair of umbilical hernia in cirrhotic ascitic patients has long been a subject of 
debate. Also, little is known about the mesh repair of umbilical hernia in those patients. The aim of this work was to evaluate the applicability and the outcome of elective mesh cone and cover repair besides, the perioperative management of ascitis. 
Patients and Methods: This non-randomized prospective controlled study included 65 cases of umbilical hernia with a small defect in ascitic patients due to liver cirrhosis, divided into 2 main groups (GI,n=30 & GII,n=35). Patients in both 2 main groups were divided into 3 subgroups. In the first subgroups (GIa,n=5 & GIIa,n=6), patients had mild ascites. Those with moderate and tense ascites were included in the second and third subgroups (GIb,n=18 & GIIb,n=20) & (GIc,n=7 & GIIc,n=9) respectively. After proper control of ascites in both groups, patients in GI were subjected to elective umbilical hernia mesh repair using cone and cover (C&C ) technique. In GII, hernias were managed conservatively and operations were only done on an emergency base using conventional repair. Patients were followed up for 2 years. 
Results: In GI, no operative mortality was recorded. Transient early postoperative ascitic fluid leakage occurred in 3 (10%) 
cases, and mild superficial wound infection in 3 (10%) more cases. There was only one case of hernia recurrence in GIc. In GII, unrepaired umbilical hernia showed incarceration in 5(17.24%) cases with 60% operative mortality, rupture in 5(17.24%) cases with 80% operative mortality, and skin pigmentation and ulceration in 14(48.28%) cases. The overall major umbilical complications in GII was 34.38%, significantly higher than in GI (3.7%) with p=0.003. The avoidance of the hernia complications related deaths in GI affected its 2 year survival (62.96%) which was considerably higher than in GII (41.38%) with p=0.1. 
Conclusion and Recommendations: Elective mesh cone and cover (C&C) technique with proper management of ascites could be proposed as a safe and effective procedure in repair of umbilical hernia with small defect in cirrhotic ascitic patients.