Objective To explore the effects of different hysterectomy approaches on postoperative recovery, pain degree and complications in patients. Methods A retrospective collection was conducted of 106 patients who underwent hysterectomy in the gynecology department of The First People’s Hospital of Kaifeng Xiangfu District from May 2023 to May 2025. These patients were divided into the laparoscopic group (58 cases) and the open surgery group (48 cases) based on the surgical methods. Perioperative and postoperative recovery parameters, visual analogue scale (VAS) scores at different time points, and postoperative complications within 30 days were analyzed. Results The intraoperative blood loss in the laparoscopic group was significantly less than that in the open surgery group (P＜0.05).The time of first getting out of bed after surgery and the time of postoperative anal gas release were significantly earlier than those in the open surgery group (both P＜0.05), and the hospitalization time was significantly shorter than that in the open surgery group (P＜0.05). There were no significant differences in operation time and the overall incidence of postoperative complications between the two groups (all P＞0.05). The VAS scores of the laparoscopic group at all time points were lower than those of the open surgery group (all P＜0.05), and the main effect of time, main effect of group and their interaction effect were all statistically significant (all P＜ 0.05). Conclusion Laparoscopic hysterectomy is associated with faster postoperative recovery and reduced pain compared with open hysterectomy, and may be preferred when appropriate conditions are met.