Caput medusae, a sign of advanced liver cirrhosis and severe portal hypertension, can present a major surgical challenge when associated with a complicated umbilical or ventral hernia due to large-volume ascites requiring surgery.

This paper describes the author’s technique of complex abdominal wall reconstruction (CAWR) using biologic mesh and reviews the literature of umbilical and ventral hernia repair in patients with cirrhosis and advanced liver disease.

The presence of caput medusae and large-volume ascites should not deter surgeons from performing hernia repair with mesh. Early elective repair of umbilical or ventral hernias in patients with cirrhosis is recommended, and primary repair without mesh should be avoided.