Surgical treatment plays an important role in the management of women with symptomatic pelvic organ prolapse (POP), particularly in those who have failed or declined conservative options. Prolapse surgery has evolved beyond the classic vaginal approach, and laparoscopy is now well established in contemporary clinical practice. The aim of POP surgery is to restore anatomy and function, reduce morbidity, and provide long-term efficacy. Factors such as age, symptoms, reproductive intent, medical comorbidities, and surgical history, as well as the patient’s personal views should be taken into consideration, ideally within a multidisciplinary team-based environment. This chapter serves to appraise the common surgical procedures undertaken to correct POP. For most women, POP is multicompartmental. By marrying up anatomy and clinical findings, one appreciates the pivotal role of the vaginal apex in orchestrating pelvic floor support and failure; surgical repair of apical descent may be enough to reduce concurrent anterior or posterior compartment prolapse. Both vaginal and abdominal routes have been employed to treat apical prolapse; published data clearly favour the abdominal sacrocolpopexy over the vaginal techniques (sacrospinous ligament fixation and uterosacral ligament suspension) in hysterectomised women. Uterine-sparing procedures, such as laparoscopic (mesh or suture) sacrohysteropexy, have gained popularity in women with a uterus in situ due to the expected benefits of abdominal support as well as a woman’s desire to preserve the uterus. With regard to isolated anterior and posterior vaginal wall prolapse, anterior and posterior colporrhaphy remain the most popular procedures, despite modest success rates of the former. The role of mesh in pelvic floor reconstruction remains an evolving issue; however, for some procedures, it is integral to providing augmented tissue support.