Background and Aims Metabolic and bariatric surgery is the primary treatment for severe obesity. However, little is known about the effectiveness of different procedures in super-obesity Chinese patients (BMI≥50 kg/m²). This study was conducted to determine the short-term efficacy of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in treating super obesity patients to provide a reference for procedure selection.Methods The perioperative and postoperative follow-up data of 71 super obese patients who were treated by SG or RYGB in the First Affiliated Hospital of Nanjing Medical University from October 2011 to September 2020 were retrospectively analyzed.Results Of the 71 patients, 37 cases underwent SG (SG group), and 34 cases underwent RYGB (RYGB group). There were no significant differences in the baseline data (sex, age, weight, and BMI) and obesity-related metabolic complications between the two groups (all P>0.05). The average operative time in the RYGB group was longer than that in the SG group [（143.4±84.5）min vs.（ 93.2±31.2）min，P=0.001], and there was no significant difference in the overall incidence of postoperative complications between the two groups (P>0.05). The postoperative one-year follow-up results showed that there were no significant differences in weight, BMI, total weight loss rate, and excess weight loss rate between the two groups (all P>0.05); in terms of the improvements in metabolic complications, the remission rates of type 2 diabetes and hyperlipidemia in RYGB group were higher than those in SG group (88.9% vs. 25.0%, P=0.021; 100.0% vs. 22.2%, P<0.001), while the remission rate of liver malfunction in RYGB group was lower than that in SG group (61.5% vs. 87.5%, P=0.011); as for the postoperative nutritional assessment, the iron deficiency, and vitamin B₁₂ deficiency rates in RYGB group were significantly higher than those in SG group (55.9% vs. 13.5%, P<0.001; 29.4% vs. 5.4%, P=0.007), the hemoglobin level was significantly lower in RYGB group (121.5 g/L vs. 135.8 g/L, P=0.033), while the folate level was higher (25.3 nmol/L vs. 17.3 nmol/L, P=0.004) than those in SG group. In addition, the incidence of vitamin D deficiency was more than 60% in both groups.Conclusion SG and RYGB are safe and feasible for super obese patients, with similar weight loss effects. RYGB is more effective for those with glycolipid metabolism disorder, while its incidence of malnutrition is also higher. SG is more suitable for super-obese patients with severe complications owing to its shorter operative time, and SG is also more effective for improving liver malfunction. Postoperative education and follow-up should be strengthened for patients to avoid the occurrence of severe malnutrition. The specific procedure selection needs to follow the principle of individualization.