Abstract: During the evolution of bariatric and metabolic surgery, various procedures have emerged, and the specialty′s nomenclature has shifted from bariatric surgery to bariatric and metabolic surgery. Currently, recommended surgical approaches by academic organizations include: Sleeve gastrectomy, Roux‑en‑Y gastric bypass, one‑anastomosis gastric bypass, sleeve gastrectomy with duodenoileal single anastomosis. Emerging procedures under investigation include sleeve gastrectomy with duodenojejunal bypass, sleeve gastrectomy with transit bipartition, sleeve gastrectomy with proximal jejunal bypass. Personalized procedure selection is a critical decision‑making challenge for bariatric surgeons. The author analyzes clinical comparisons of common procedures to guide decision‑making in clinical practice.