Background: Obesity is a prevalent health concern worldwide, affecting various aspects of patient care and surgical outcomes. Total laparoscopic hysterectomy (TLH) is a common gynecological procedure, but its impact on obese patients remains an area of interest. Understanding the perioperative challenges and financial implications associated with TLH in obese individuals is crucial for optimizing patient care and resource allocation. Objectives: to assess perioperative problems and financial outcomes in obese who undergo total laparoscopic hysterectomy (TLH), in comparison to nonobese. Patients and methods: A retrospective cohort study conducted on patients who underwent TLH at Benha university hospital and private centers over 5 years, to compare the TLH outcomes between class 1 and 2, with BMI between 30-39.9 kg/m2and nonobese with BMI 18.5 - 29.9 kg/m2. Results: Among the 360 patients, who underwent TLH, 140 were obese (class 1 or 2) and 220 were nonobese. Surprisingly, there were no statistically significant differences in intraoperative complications between the two groups (P>0.05). However, the impact of obesity class on clinical and financial outcomes was evident. Obese patients experienced longer hospital stays, increased operative blood loss, higher drug consumption, and elevated costs. Notably, the incidence of surgical site infections and overall postoperative complications was significantly higher in obese patients (P<0.05). Conclusion: Successful execution of TLH is feasible in obese patients, despite the higher adverse perioperative clinical and financial consequences associated in obese class 1 and 2 patients when compared to nonobese patients.