Purpose The optimal management of complicated umbilical hernia in patients with liver cirrhosis is still undefined. The purpose of this study is to evaluate the use of polypropylene mesh to treat complicated umbilical hernia in cirrhotic patients. Methods In the period from January 2005 to May 2008, 80 patients with complicated umbilical hernia combined with liver cirrhosis underwent hernia repair. The patients were randomly divided into two groups; each group consisted of 40 patients. Hernia repair was carried out by conventional fascial repair in group I and by mesh hernioplasty in group II. Results The male/female ratio, Child-Pugh class, and mode of hernia complication were almost matched in both groups. Hernia recurrence was significantly less in the mesh hernioplasty group. No mesh exposure or fistulae were experienced. There was no need to remove any of the meshes. Conclusions Permanent mesh can be used in complicated hernias in cirrhotic patients with minimal wound-related morbidity and a significantly lower rate of recurrence.