Background: Hernias in cirrhotic patients with ascites may develop severe complications. Acute umbilical hernia rupture in cirrhotic patients is unusual but potentially life-threatening. Cirrhotic patients with ascites have reduced hepatic reserve and poor tolerance of surgical and anesthetic stresses. Patients and methods: A prospective randomized controlled study of cirrhotic patients with ascites presented with a spontaneously ruptured umbilical hernia who were equally subdivided into two groups. Group I: the peritoneum was closed separately by continuous Vicryl ® 2-0 suture, then the sheath was closed by continuous Prolene ® 0 suture in two layers. In group II: defect closure in two layers, the first layer was mass closure of the peritoneum and sheath by continuous Prolene ® 0 suture, and the second layer was a continuous stitch to invaginate the previous layer. Results: Twenty-two cirrhotic patients with ascites presented with ruptured umbilical hernia were randomly subdivided into two groups each group of 11 patients. There were 7 males and 4 females with a mean age of 51.36±5.92 in group I, while in group II, there were 6 males and 5 females with a mean age of 49.9 ±5.7. operative time was longer in group I than in group II with p-value= 0.000066. There was no postoperative ascites leakage in group I, while there was leakage in 4 cases in group II. This was statistically significant with p-value of 0.027 Conclusion: Spontaneously ruptured umbilical hernia in cirrhotic patients can be managed safely under local anesthesia in well-selected patients. Separate closure of the peritoneum prevents the ascites leak through the repaired defect.