Umbilical hernias account for a large portion of anterior abdominal wall defects both in the United States and globally. Constituting a notable percentage of the “bread and butter” practice of the general surgeon, surgeons sought, early on, to understand the pathophysiology of this diagnosis and the best corresponding treatments. Nevertheless, controversy regarding the optimal workup and management of these hernias still prevails. The workup of umbilical hernias is currently highly variable with no definite algorithm or guidance. While historically the only management option of umbilical hernias was the primary suture repair, today there exist several repair techniques that may complicate the decision-making process. The spectrum of surgical options ranges from the open method (with suture or mesh repair) to the minimally invasive modality (with the mesh in the underlay, sublay, or onlay position). This chapter will discuss the various aspects of this pathology, including etiologies and predisposing factors, classifications, and optimization prior to surgery. Additionally, an algorithm will be proposed for both the workup and surgical management of umbilical hernias. The chapter will also detail the technical aspects of the most common open and minimally invasive repair approaches.