Pope Francis has had surgery to remove intestinal scar tissue and repair a hernia in his abdominal wall, the latest maladies to befall the 86-year-old pontiff who had part of his colon removed two years ago.

The Vatican said there were no complications during the three-hour surgery, which required him to be under general anaesthesia. The pontiff was expected to remain at Rome’s Gemelli Hospital for several days, and all papal audiences were cancelled until June 18.

Dr Sergio Alfieri, director of abdominal and endocrine sciences at Gemelli, who also performed Pope Francis’ 2021 colon surgery, said the operation was successful. A short time later, the pope was awake, alert and even joking.

“When will we do the third one?” he quoted the Pope as saying.

During the operation, doctors removed adhesions, or internal scarring, on the intestine that had caused a partial blockage, as well as pain in recent months. Alfieri revealed that Francis had undergone previous undisclosed abdominal surgeries sometime before 2013 in Argentina, which had also caused scarring.

To repair the hernia that had formed over a previous scar, a prosthetic mesh was placed in the abdominal wall, Alfieri said. He added the Pope was suffering from no other pathologies, the tissue removed was benign and that after he recovers, he should be fine.

A feared protrusion, or bulging of the intestine through the hernia tear, was apparently not found.

“It appears they operated on him in a timely fashion with no compromise to his intestine,” said Dr Walter Longo, chief of colon and rectal surgery at Yale University School of Medicine, who did not participate in the surgery and commented after consulting the Vatican statement on the procedure.

The car carrying Pope Francis to the Agostino Gemelli University Polyclinic leaves the Vatican. Photo / AP

Hernia operations are rarely performed on an emergency basis, and Alfieri said the surgery had been planned. While unannounced publicly, it appeared timed so Francis would have ample time for recovery ahead of a busy travel schedule later this summer.

At three hours, the Pope’s procedure was considerably longer than the standard 60 to 90 minutes doctors say a hernia operation usually takes, but Alfieri noted that the scar tissue from the previous surgeries was completely removed.

Spending more time under anaesthesia, coupled with being on a ventilator for so long — in someone who has lost part of one lung as a young man — could put the pontiff at risk of breathing complications or a longer-than-expected recovery time, experts said.

Pope Francis remained in charge of the Vatican and the 1.3-billion-strong Catholic Church, even while unconscious and in the hospital, according to canon law.

In July 2021, Francis spent 10 days at Gemelli to remove 33cm of his large intestine. In an interview with The Associated Press in January, Francis said the diverticulosis, or bulges in his intestinal wall, that prompted that surgery had returned.

After that surgery, Francis lamented that he hadn’t responded well to the general anaesthetic. That reaction in part explained his refusal to have surgery to repair strained knee ligaments that have forced him to use a wheelchair and walker for over a year.

However, Alfieri said Francis had no adverse reactions to the anaesthesia in 2021 or Wednesday.

“Clearly no one likes to be operated on and put to sleep because the moment we’re put under, we lose consciousness,” he told an evening news conference at the hospital with the Vatican spokesman by his side. “But there was no physiological problem two years ago or today.”

Dr Manish Chand, a professor of surgery at University College London who specialises in colorectal surgery, said the greatest issue afterwards would be pain management and making sure the wound heals properly.

“In the first six weeks after this type of surgery, you’re at risk of getting a recurrence,” he said. To avoid that, patients are advised not to do anything strenuous.

Dr Robin Phillips, an emeritus professor of colorectal surgery at Imperial College London, pointed out that abdominal surgery can also compromise lung function.

The Argentine Pope had part of one lung removed when he was a young man. In late March, Francis spent three days at Gemelli for bronchitis and was treated with intravenous antibiotics. He emerged on April 1 saying “Still alive!”

“I suspect they are doing it now because they are worried it might become more complicated and result in an emergency operation, which would carry an even bigger risk than leaving it alone or operating now,” Phillips said.

After celebrating his weekly general audience, the Pope was driven in his Fiat 500 out of the Vatican shortly after 11am and arrived at the Gemelli some 20 minutes later, escorted by police.

“The stay at the health facility will last several days to allow for the normal postoperative course and full functional recovery,” the Vatican said in a statement.

The Pope had appeared in good form on Wednesday morning at his audience in St Peter’s Square, zipping around the square in his Popemobile greeting the faithful. He also had two meetings beforehand, the Vatican said.

Francis has had a packed schedule of late, with multiple audiences each day. The Vatican recently confirmed a travel-filled August, when the Holy See and Italy are usually on vacation. He has a four-day visit to Portugal scheduled for the first week of August and a similarly long trip to Mongolia starting on August 31.

In a sign that the trips were still on, the Vatican this week released the planned itinerary for Francis’ visit to Portugal for World Youth Day events from August 2 to August 6. The busy schedule includes all the protocol meetings of an official state visit plus multiple events with young people and a day trip to the Marian Shrine of Fatima.

-  Nicole Winfield, Trisha Thomas, Maria Cheng, AP