A Comprehensive Guide to What is a Bougie in Surgery?

September 30, 2025 •

4 min read

A 2021 meta-analysis found comparable safety and efficacy between bougie and balloon dilation for benign esophageal strictures, highlighting the specialized role of this flexible instrument in medical procedures. But what is a bougie in surgery, and why is this tubular tool so important across different fields? This article explores its various functions, from assisting with intubation to calibrating stomach sizes in bariatric surgery.

Quick Summary

A surgical bougie is a flexible, tube-like medical instrument used for diverse procedures. Its functions include guiding endotracheal tubes during difficult intubations, calibrating the stomach pouch in bariatric surgery, and dilating narrowed anatomical passages such as the esophagus.

Key Points

Multi-Purpose Tool: A bougie is a flexible, tubular medical instrument with diverse applications, including airway management, esophageal dilation, and gastric calibration in surgery.
Intubation Guide: In anesthesia, a bougie, or tracheal introducer, guides an endotracheal tube into the trachea, particularly useful when visualizing the vocal cords is difficult.
Calibration in Bariatric Surgery: During procedures like sleeve gastrectomy, a bougie serves as a sizer to ensure the new stomach pouch is a consistent and safe diameter.
Dilation of Strictures: In gastroenterology, specialized bougies are used to widen narrowed passages like the esophagus, either blindly or over a guidewire.
Procedure-Specific Types: Different bougies are designed for specific anatomical areas, such as airway bougies for the trachea and dilating bougies for the esophagus or urethra.
Tactile Feedback: Experienced users of airway bougies can feel distinct 'clicks' as the device passes over the tracheal rings, confirming correct placement.
Associated Risks: Potential complications include perforation of organs like the esophagus, trachea, or stomach, especially if used improperly or without sufficient skill.

A bougie is a flexible, tubular medical instrument used in various surgical and medical settings to help guide a device or dilate a passage. While the word itself is derived from an old French term for wax candles, the modern medical bougie is a far more sophisticated tool, typically made of plastic or silicone. Its applications are diverse, requiring different designs depending on the anatomical area and procedural goal.

The Airway Bougie: A Lifesaving Guide for Anesthesia

Perhaps the most well-known application of a bougie is in airway management, where it is formally known as a tracheal introducer. This instrument is a crucial aid during endotracheal intubation, particularly when a direct view of the vocal cords is limited—a situation known as a 'difficult airway'.

How the Airway Bougie Works

The procedure for using an airway bougie is often described as 'railroading' the endotracheal tube (ETT) into place.

Laryngoscopy: The clinician first performs a laryngoscopy to visualize the airway. If the view of the glottic opening is poor, they can insert the bougie. The distal tip, often featuring a specific angle called a 'coudé tip,' helps navigate the anatomy.
Tactile Confirmation: The clinician advances the bougie toward the trachea. As the tip slides over the tracheal rings, it produces a distinct tactile sensation, often described as 'clicks,' which confirms correct placement within the trachea. If the bougie enters the esophagus, this clicking sensation is absent, providing crucial feedback to the operator.
Endotracheal Tube Advancement: Once the bougie is secured in the trachea, the ETT is threaded over it and advanced into position.
Removal: The bougie is then carefully withdrawn, leaving the ETT in place for ventilation.

Key Features of an Airway Bougie

Material: Often made of woven polyester coated in resin or thermoplastic polyurethane.
Length: Typically around 60 to 70 cm for adult versions.
Tip: Often features a curved, or coudé, tip to aid in maneuvering past the epiglottis and into the trachea.

The Esophageal Bougie: Dilating Narrow Passages

In gastroenterology, a bougie is used as a dilator to treat esophageal strictures, or narrowing of the food pipe.

Treating Esophageal Strictures

Esophageal strictures can be caused by various factors, including acid reflux, inflammation, or tumors. The goal of dilation is to stretch the constricted area, making it easier for the patient to swallow. This is typically done as an outpatient procedure and may require multiple sessions to achieve the desired result.

Types of Esophageal Bougies

Weighted Bougies (Hurst/Maloney): These flexible, non-wire-guided dilators are weighted with materials like tungsten (replacing older mercury versions) to aid gravity in their descent. They feature rounded or tapered tips and are sometimes used for self-dilation.
Wire-Guided Bougies (Savary-Gilliard): These bougies are passed over a guidewire that has been placed endoscopically past the stricture. This method provides greater control and is often preferred for complex strictures.

The Bariatric Bougie: A Sizing Tool in Weight Loss Surgery

In bariatric surgery, a specialized bougie is used during procedures like sleeve gastrectomy to create the new, smaller stomach pouch.

Calibrating the New Stomach

During a sleeve gastrectomy, a surgeon removes a large portion of the stomach to create a narrow, banana-shaped gastric sleeve. The bougie is inserted into the stomach and acts as a mold or sizer, guiding the stapler line to ensure the new pouch has the correct, consistent diameter. This calibration is critical for achieving optimal surgical outcomes while preventing complications like stricture formation.

Ensuring Consistency and Safety

Different bougie sizes are available, and the surgeon's choice can impact the final size of the gastric sleeve. Using a bougie helps standardize the procedure, ensuring that the new stomach's size is appropriate for the patient and contributes to predictable weight loss.

Bougie Comparison: Different Applications, Different Tools

Different bougies serve different purposes and have distinct characteristics, which can be compared with alternative instruments.


Feature	Airway Bougie	Esophageal Bougie	Bariatric Bougie (Sizer)
Primary Function	Guide endotracheal tube placement.	Dilate esophageal strictures.	Calibrate stomach size during sleeve gastrectomy.
Typical Material	Woven polyester, resin, PVC, or PET.	Silicone, PVC, or metal.	Custom thermoplastic polyurethane.
Mechanism	Used as a guide rail for the ETT.	Passively dilates or stretches the lumen.	Acts as a rigid form against which a stapler is fired.
Guidance	Visual or tactile feedback.	Blindly (weighted) or fluoroscopically/endoscopically (wire-guided).	Visual via laparoscopy.
Compared to...	Endotracheal tube stylet, but offers better success in difficult airways.	Balloon dilator, offering tactile feedback.	Visual estimation, providing greater accuracy.

Risks and Considerations When Using a Bougie

While highly effective, the use of a bougie carries inherent risks that medical professionals must manage carefully. These complications underscore the importance of proper training and technique.

Perforation: One of the most serious risks is the perforation or laceration of an organ. This can occur in the esophagus, trachea, or stomach, especially during complex procedures or with improper manipulation.
Airway Trauma: During intubation, a bougie can cause trauma to the trachea or vocal cords if handled too aggressively.
Device Fracture: Some reusable or defective bougies can fracture during a procedure, creating a dangerous situation.
Infection Risk: Reusable bougies require meticulous sterilization to prevent the transmission of infections. Modern, single-use bougies have mitigated this risk.

Conclusion

A bougie is not a single tool but a category of flexible, tubular instruments, each expertly designed for a specific surgical or medical application. Whether it is guiding a crucial intubation in the operating room, dilating a narrowed esophagus in a gastroenterology clinic, or calibrating the stomach in a bariatric procedure, the bougie serves as a vital aid to surgical precision and patient safety. Its versatility and effectiveness, particularly in challenging scenarios, make it an indispensable part of a surgeon's toolkit. Understanding what a bougie is in surgery, along with its specific functions and risks, is essential for appreciating its significant role in modern medical practice. For further information on related technologies, one can explore comprehensive resources like the Anesthesia Key chapter on tracheal introducers.

Frequently Asked Questions

An airway bougie is a thin, flexible device used to guide the endotracheal tube into the trachea, especially when visualization is limited. A stylet is a malleable wire inserted into the tube to give it a specific shape but is less effective for guiding in difficult airways.

For a difficult intubation, a bougie is first passed into the trachea. Its length and flexible, angled tip allow it to be advanced even when the vocal cords are not fully visible. The endotracheal tube is then threaded over the bougie and into place, using it as a guide.

Esophageal dilation is a procedure that uses a series of increasingly larger, cone-shaped bougies to stretch and widen a narrowed esophagus (a stricture), improving the patient's ability to swallow.

In bariatric procedures like sleeve gastrectomy, a bougie is inserted to serve as a guide and sizer for the stapling device, ensuring the creation of a consistent and appropriately sized stomach pouch.

Potential risks include perforation or laceration of organs such as the esophagus, trachea, or stomach. Airway trauma and excessive bleeding are also possible, particularly if the procedure is complex or the instrument is handled improperly.

While all bougies act as dilators, the term "bougie" is often used specifically for the flexible, tube-like devices used in airway management and gastric sizing. Other dilators, such as balloons, are also used in procedures like esophageal dilation.

Yes, some patients with specific conditions, such as certain esophageal strictures, may be trained to use non-wire-guided bougies (e.g., Maloney dilators) for self-dilation at home.