**13. Conclusion**

The assessment of recurrent pelvic floor dysfunction can be done clinically aided with imaging. The patient records of previous surgery are important. Vaginal apical prolapse surgery should always be combined with meticulous culdoplasty to correct the enterocele that is associated with vaginal prolapse.

When the previous surgery is sacrospinous ligament suspension, recurrent anterior vaginal prolapse is common as the vaginal axis gets deflected in sacrospinous fixation and the lines of force by increased intraabdominal pressure are directed across the vagina.

Each case should be individualized; keeping in mind the etiology of recurrent prolapse and surgical correction directed towards the cause. It is unclear whether the best route of surgical reconstruction for post hysterectomy vaginal apical prolapse is abdominal or vaginal. The most proper reconstructive surgery should be site specific, individualized and based on operating surgeon's expertise and experience.
