To determine the difference in surgical complications for patients with a prior cesarean section (CS) undergoing abdominal, vaginal or laparoscopic hysterectomy. A population based retrospective cohort study. Province of Ontario, Canada. 10 300 patients with at least 1 CS between July 1, 1991 and February 17, 2018. Benign, non-gravid hysterectomy between Apr 1, 2002 and March 31, 2018. The primary outcome was a composite of all surgical complications within 30 days of surgery. Secondary outcomes were rate of genitourinary complications, readmission to hospital and emergency department visit occurring within 30 days of surgery. Of 10,300 patients who had at least one previous CS, who underwent subsequent hysterectomy for a benign indication, 7370 underwent an abdominal hysterectomy (71.55%), 813 (7.9%) had a vaginal hysterectomy and 2117 (20.55%) underwent a laparoscopic hysterectomy. The adjusted odds of any surgical complication from hysterectomy was significantly lower when performed by the vaginal approach compared to the laparoscopic approach (OR 0.32 95% CI 0.20-0.51 p<0.0001). There was no difference in the odds of surgical complication between abdominal and laparoscopic approaches (OR 1.09 95% CI 0.87-1.37, p=0.45). Our retrospective population-based study demonstrates that after previous cesarean section, patients selected to undergo vaginal hysterectomy, experienced lower risk than either abdominal or laparoscopic approaches. This suggests that cesarean section alone should not be a contraindication to vaginal hysterectomy.