Objective This study aims to compare the outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) in patients with and without prior abdominal surgery, focusing on key factors such as blood loss, operative time, complication rates, and hospital stay. The primary aim is to assess the impact of previous abdominal surgery on surgical outcomes. Methods A retrospective cohort study was conducted at a private hospital in Saudi Arabia between January 2019 and July 2024. The study included patients who underwent TLH or TAH, with or without prior abdominal surgery, such as cesarean sections (CSs), appendectomies, cholecystectomies, and hernia repairs. A total of 163 procedures were performed by a single surgeon. Patients aged 18-70 years were included, while cases in which a hysterectomy was immediately followed by an elective CS were excluded to prevent bias in operative time and blood loss measurements. Surgical outcomes were then compared between groups. Results A total of 151 patients were included, with 56 undergoing TLH and 95 undergoing TAH. Prior abdominal surgery was present in 24 (42.9%) TLH patients and 33 (34.7%) TAH patients. Median blood loss was significantly lower in the TLH group (200 mL, IQR: 100-300) compared to the TAH group (300 mL, IQR: 200-500) (p = 0.00). The median hospital stay was also shorter for TLH patients (two days, IQR: 1-3) than for TAH patients (two to three days, IQR: 2-3) (p = 0.00). There was no significant difference in operative time between TLH (98.5 minutes, IQR: 83.25-116.5) and TAH (95 minutes, IQR: 76-120) (p = 0.633). Complications occurred in four (7.1%) TLH patients and seven (7.4%) TAH patients, with bladder injuries reported in two patients from each group and bowel injuries in three TAH patients. The majority of patients in both groups experienced no complications (92.9% in TLH and 92.6% in TAH). Conclusions TLH provides significant advantages over TAH, including reduced blood loss and shorter hospital stays, even in patients with prior abdominal surgeries. It remains a safe and effective option when performed by experienced surgeons. However, the choice between TLH and TAH should be individualized, taking into account factors such as the extent of adhesions, surgical expertise, and patient health. Further research is recommended to optimize outcomes in complex cases.