Vaginal vault prolapse is a common complication following hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualized, taking into consideration the surgeon's experience, patient's age, comorbidities, previous surgery and sexual life. Objective: To compare the outcome between simple hysterectomy and hysterectomy with autologous rectus sheath sling in valurnalble patients for vault prolapse and any specific post-operative or long term complications after prophylactic sling. Material & method: This prospective case control study was carried out atBahawal Victoria Hospital, Bahawalpur from June 2008 to Dec. 2010. Total 56 patients were included in this study. Age range of the patients were from 30-45 years. Results: About 55% of women were from village and hard working. Due to poor nutritional status and multiple child birth assisted TBAS or even without any assistance some time, with minimum birth spacing all the uterine support were very weak and vagina was found lax with first or second degree perinial tear. pouch of douglas was found very deep preoperatively in all cases. So vault sling was done in those vulnerable cases with rectus sheath sleeve. Average post-operative hospital stay was 6 days. All patients compaliants of usual post operative pain for 3 to 4 days but 75% of the patient complained pain in both iliac region along with the usual post-operative pain upto 9th to 10th day and 10% complained slight dragging pain at the same point upto 6 weeks post operatively. Vaginal vault prolapse was found in one (3.6%) patient only during consecutive two and halfyear'sfollow-up period in Group A. The technique of vault sling was very simple & needs only few minutes to complete the procedure without extra financial cost. Conclusion: The conclusion of my study is whenever abdominal hysterectomy a prophylactic sling of vaginal vault with rectus sheath should be done in vulnerable patientsas its outcome is more favorable as compare to conventional abdominal hysterectomy.