Sleeve gastrectomy and gastric bypass surgery are two commonly used surgical procedures for weight loss and metabolic surgery, and they are also the mainstream procedures selected by domestic experts in weight loss and metabolic surgery according to the characteristics of the Asian population, especially gastric bypass surgery, which is also known as the “gold standard” procedure for weight loss and diabetes. These two procedures have their own advantages and disadvantages due to different surgical mechanisms. Gastric bypass surgery not only reduces the volume of the stomach, but also modifies the intestinal structure and limits absorption, so the treatment effect is better; while sleeve gastrectomy is relatively simple, the operation time is shorter and the safety is higher, but because it only limits the volume of the stomach, the effect of weight loss and diabetes treatment may not be satisfactory, which is why many doctors tend to recommend gastric bypass. But a longer operation also means longer anesthesia, which increases the risk for those with severe obesity and especially cardiopulmonary insufficiency, in which case sleeve pulses become a better option. The sleeve puls is a jejunostomy in which the surgeon removes a portion of the patient’s intestine to achieve a similar restriction of absorption as a gastric bypass. Compared to sleeve gastrectomy, sleeve gastric pulses have better weight loss results, and compared to gastric bypass, they are simpler and have improved the potential for micronutrient deficiencies. Although bariatric metabolic surgery is now a very mature surgical procedure, it is still being improved and progressed, and it is believed that in the future, with further research and development of medical devices, bariatric metabolic surgery will bring us more surprises.