Objective: Benign tracheal stenosis after endotracheal intubation is a common iatrogenic problem with impactable psychological and socioeconomic burden on health care needs immediate intervention. There are no clear cut guidelines on definitive therapy for tracheal stenosis and consensus on definition of good outcome. Endoscopic dilatation is usually preferred in patients with mild stenosis of grade I or II and a stenotic segment of <1 cm. Patients with complex grade III and IV stenosis requires proper planning and evaluation before definitive surgery or palliative procedure like stenting, dilatation. But all patients with tracheal stenosis do not present to hospital in stable condition. Many patients present with acute respiratory distress with unstable general condition requires immediate intervention to tide over the crisis and buy time for stabilization and further evaluation before planned procedure. Other procedures like baloon dilatation, laser coagulation not feasible in that acute crisis situation. Gum elastic bougie dilatation is available in all establishments and can be performed with ease and cost effectively. But limited data and study literature available on the role of dilatation in complex and grade III and IV stenosis. This study is to know the role of bougie dilators in grade III and IV and complex type of benign tracheal stenosis. Patients and methods: in our institution 149 patients with complex stenosis grade III and IV Myer-Cotton classification underwent treacheal stenting with Montgomery T-tube for benign tracheal from Jan 1984 to Jan 2019. Those patients with simple stenosis and grade I and II Myer-Cotton classification were excluded from the study. Not all 149 patients were directly taken for T-Tube insertion as many of them presented in acute respiratory crisis and stridor. These were stabilised before T-tube stenting by bronchoscopic gradual dilatation with carrot type elastic bougie and followed up with bronchoscopic evaluation. Results: Totally 149 patients underwent T-tube insertion for benign tracheal stenosis 25 (17%) were prior tracheostomised and 124 (83%) complex grade III and IV stenosis. Out of 149 patients 61 (41%) were treated initially with dilatation before T-tube insertion. 5 (8%) developed Subcutaneous emphysema and 3 (5%) had pneumothorax. 40 patients 65% underwent subsequent planned procedure within 72 hours (3 days) and 21 (35%) within 48 hours (2 days). Conclusion: elastic bougie dilatation has definite role in complex tracheal grade III and IV stenotic patients who are presented with acute respiratory distress to tide over the crisis and buy time to plan and work up for definitive subsequent procedures. Gum elastic bougie dilators are simple to use and much cheaper than balloon dilators. Advantages of dilation were the provision of both visual and tactile feedback to the operating surgeon. Infrastructure facility for rigid elastic bougie is simple, easily available and easily reproducible at all centres.