Identification of post-transplant lymphocele using lymphatic mapping with isosulphane blue

Lymphocele development after renal transplantation is a well-recognized complication that occurs with the incidence of 0.6-18%. Although the majority of patients are asymptomatic, post-renal transplant lymphocele continues to be a major cause of morbidity if it is left untreated. The standard approach for the treatment of symptomatic lymphoceles is accepted to be laparoscopic or open marsupialization in many centers if simple drainage and conservative measures fail. However, marsupialization is almost impossible under certain circumstances, such as in the case of excessive abdominal adhesions. Hence, direct visualization of the lymphatic leak and suture ligation may become inevitable, which is usually a challenging procedure for the surgeon. Herein we report a case of post-renal transplant lymphocele treated by the direct identification and suture ligation of injured lymphatic vessel using a new method similar to sentinel lymph node detection using the dye isosulphane blue.