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Introduction: Pelvic Organ Prolapse is a common and debilitating condition occurring in women. The protruding organ can be the uterus and the cervix, the bladder, the rectum, the intestines or a combination of the above. Vaginal hysterectomy with or without anterior colporrhaphy and posterior colpoperineorrhaphy is a treatment for uterovaginal prolapse in women. However, visceral adhesions due to prior surgeries or chronic pelvic ailments like pelvic inflammatory disease or endometriosis often pose a hindrance to the successful execution,??necessitating conversion of to the abdominal route. We discuss a case of vaginal hysterectomy in a woman with multiple??previous pelvic surgeries. Case Report: 40 year old P2L2 (Previous 2 LSCS) presented with complaints of something coming out per vaginum since 7 years. History of bladder extrophy at birth for which she had undergone 2 surgeries at the age of 5 years and 7 years respectively. History of a failed abdominal sling surgery done 4 years ago. Per speculum examination showed Third degree uterovaginal prolapse with minimal cystocele. Perineum was lax and cervix elongated. No stress urinary incontinence. on per vaginal examination, Uterus was normal in size, ventrofixed. Bilateral adnexae were clear. Uterocervical length was 10 cm. After all preoperative preparations, the patient underwent a vaginal hysterectomy with anterior colporrhaphy and posterior colpoperineorrhaphy under spinal + epidural anesthesia. Conclusion: Women are increasingly undergoing multiple surgeries during their reproductive and menopausal life. Pelvic surgeons are encountering more such patients and have to take additional care to prevent complications, reduce morbidity and improve safety. This route was particularly suitable in this patient as she had multiple complex abdominal surgeries which would have been difficult if a laparotomy or laparoscopy was attempted. A correct concept of pelvic anatomy and a concrete perioperative plan is necessary to improve the chances of success in such cases.