JERUSALEM — In an ominous development, critically ill Prime Minister Ariel Sharon was rushed Friday into his third round of surgery in two days to stem new bleeding in his brain.
Doctors said they managed to halt the bleeding, and also took measures to relieve pressure that had built up in Sharon's skull in the wake of the massive cerebral hemorrhage he suffered Wednesday night.
After the five-hour operation, Hadassah University Medical Center director Dr. Shlomo Mor-Yosef described Sharon's condition as "difficult but stable." The Israeli leader, still in a deep coma induced Thursday by doctors, was returned to the hospital's neurological intensive-care unit.
Despite what Mor-Yosef described as a "significant improvement in the way [Sharon's] brain looks," there did not appear to be any change in the overall grim prognosis. Aides and doctors have acknowledged that even if the prime minister survives, the brain damage he has probably suffered will preclude a return to his duties.
Outside experts said Friday's measures had probably done little more than stave off the immediate crisis.
"They probably accomplished the initial goal of keeping him alive," said Dr. Keith A. Siller, a neurologist and medical director of the New York University Comprehensive Stroke Care Center. "He's still far from being out of the woods. Overall, his prognosis is still very, very poor."
As the 24-hour Jewish Sabbath began at dusk Friday, religious leaders continued to call for prayers for the prime minister's recovery.
Sharon fell ill Wednesday night at his sheep ranch in the Negev desert on the eve of what was to have been a procedure to repair a congenital heart defect. That defect, a hole about an eighth of an inch wide, is thought to have contributed to a minor stroke Sharon suffered Dec. 18 by allowing a blood clot to travel to his brain, in what is known as an ischemic stroke.
Treatment of the initial stroke involved the use of blood thinners, which in turn made it more difficult for doctors to halt bleeding after Wednesday's hemorrhagic stroke.
Debate continued Friday in Israel over whether doctors had acted unwisely in administering the blood thinners; allowing Sharon to resume a strenuous work schedule days after the minor stroke; and transporting him Wednesday night to Jerusalem by ambulance, a 90-minute ride, rather than airlifting him or rushing him to a hospital closer to his ranch.
Doctors said Sharon would probably be kept in a coma until at least Sunday and perhaps longer to allow swelling to go down and to aid in his overall recuperation. Until physicians try to bring him out of the coma, it will be impossible to assess the full extent of the neurological damage he suffered, but doctors have indicated they expect it to be severe.
The prime minister's sons, Omri and Gilad, were at their father's bedside, taking turns sleeping in the next room, and aides have also been keeping a round-the-clock vigil. Sharon's sons, particularly Gilad, to whom Sharon is very close, are thought to have legal authority to make decisions regarding the course of their father's treatment.
Some eminent Israeli neurologists have been quoted anonymously in media reports as saying that measures taken so far -- three lengthy and invasive surgeries to halt bleeding -- are already more extreme than what would be considered normal in the case of a patient of Sharon's age and condition. A month short of his 78th birthday, the Israeli leader is grossly overweight, estimated to carry more than 300 pounds on a 5-foot-7-inch frame.
Siller, the New York University neurologist, described the surgeries carried out so far as "lifesaving maneuvers."
"We don't typically operate on hemorrhagic strokes," he said. "When the hemorrhage is this massive, we usually don't recommend heroic measures."
Temporary leadership of the country has been handed to Vice Prime Minister Ehud Olmert, a close political ally of the prime minister. But many analysts doubt that Olmert has sufficient stature and following to be the long-term successor to Sharon, one of the most popular prime ministers in modern Israeli history.
Less than two months before his collapse, Sharon founded a new centrist party, Kadima, or Forward, which quickly garnered a commanding lead in polls heading into Israel's March 28 parliamentary elections. Early indications were that voters were still inclined to support Kadima, even without Sharon.
A poll published in Friday's editions of Israel's largest newspaper, Yediot Aharonot, forecast that if led by Olmert, Kadima would win 39 of the 120 seats in the Knesset, or parliament. That is only about three fewer seats than polls had suggested a Sharon-led party would garner, but analysts warned that the current support could be based largely on sympathy for the stricken prime minister.
Kadima's platform calls for finding a solution to the conflict with the Palestinians and creating a Palestinian state. But Palestinians have complained bitterly about Sharon's intention to retain large Jewish settlement blocks in the West Bank.
Olmert met Friday with Shimon Peres, the elder statesman who abandoned his Labor Party in November to join Kadima. Had Sharon not fallen ill, Peres would have been in line for a senior Cabinet post in any new Kadima-led government.
Reassurances were reportedly being made by Olmert, who is eager to keep Peres in the fold, but a meeting was cut short by word that Sharon was being rushed into surgery.
As acting prime minister, Olmert spoke by telephone Friday with U.S. Secretary of State Condoleezza Rice.
Amid the uncertainty over the survival of Sharon, a central figure in U.S. Mideast policy, Rice canceled a trip to Indonesia and Australia, the State Department said.
Times staff writer Karen Kaplan in Los Angeles contributed to this report.