Purpose <p>Umbilical hernia repair in patients with medically refractory ascites poses a significant challenge for clinicians. Optimization of ascites prior to surgical intervention is recommended due to improved post-operative outcomes. The alfapump® is a battery-operated device that directs ascites into the bladder for excretion and can be utilized in patients with medically refractory ascites. We present a patient with medically refractory ascites that underwent implantation of the alfapump® allowing for elective umbilical hernia repair.</p> Methods <p>A 70-year-old male with medically refractory ascites in the setting of a recurrent symptomatic umbilical hernia underwent implantation of the alfapump®.</p> Results <p>The patient was followed in the outpatient setting and maintained adequate control of his ascites following implantation of the alfapump® device. He subsequently underwent a robotic repair of his umbilical hernia. Post-operatively, the patient did not experience a recurrence or complications related to the hernia repair.</p> Conclusion <p>Hernia repair in the setting of medically refractory ascites pose a challenge for surgeons. The implantation of the alfapump® may be a viable option to control medically refractory ascites allowing for elective hernia repair.</p>