Which type of bariatric surgery least affects the bioavailability of DOACs?

Sleeve gastrectomy is the type of bariatric surgery that least affects the bioavailability of Direct Oral Anticoagulants (DOACs). This surgical approach primarily involves the removal of a portion of the stomach, which results in a tubular stomach shape, and does not involve any alterations to the intestines or rerouting of digestive processes.

Consequently, because the integrity of the gastrointestinal tract remains largely intact, the absorption of medications, including DOACs, is less likely to be significantly impaired. Unlike other bariatric procedures, sleeve gastrectomy minimally disrupts the normal pathway of medication passage, which is crucial for ensuring the optimal bioavailability and therapeutic effect of drugs that rely on gastric and intestinal absorption.

In contrast, other forms of bariatric surgery, such as Roux-en-Y gastric bypass and biliopancreatic diversion, create significant changes to the anatomy of the gastrointestinal system that can greatly alter drug absorption and bioavailability. These procedures involve rerouting the intestines or bypassing parts of the digestive tract, leading to potential malabsorption of various nutrients and medications, including DOACs.

Adjustable gastric banding is less invasive and maintains more normal gastrointestinal integrity than bypass or diversion surgeries. However, it can still affect