Background Umbilical hernia had been found to occur in 20% of cirrhotic patients with decompensated liver cell failure who had ascites; in such patients, umbilical hernia had a marked liability for complications such as irreducibility, obstruction, and strangulation. Management of complicated hernias especially irreducible hernias in such patients could be done by excision of the hernial sac, closure of the defect and then fixation of the prolene mesh (hernioplasty), or by reduction and repair in two layers of continuous sutures using polypropylene sutures without mesh (herniorrhaphy). Aim The aim of our study was to compare hernioplasty with the use of prolene mesh and the conventional anatomical repair (herniorrhaphy) in complicated umbilical hernia in patients with decompensated liver cell failure. Patients and methods In our descriptive study, we included 101 cases who were followed up for a period of 24 months, and we divided them into two groups: group A contained cases who had complicated umbilical hernia and were managed by hernioplasty with the use of prolene mesh, and group B contained cases that had complicated umbilical hernia and were managed by reduction and repair in two layers of continuous sutures using polypropylene sutures without using a mesh (herniorrhaphy). Results We found a statistically significant difference between both groups regarding recurrence of the umbilical hernia and duration of hospital stay (days) (P=0.004). Conclusion Complicated umbilical hernia in cirrhotic patients with decompensated liver cell failure who were managed by hernioplasty with the use of prolene mesh showed lower incidence of recurrence than the conventional anatomical repair (herniorrhaphy).