Abstract Background We undertook a systematic review and meta-analysis to compare surgeon-performed ultrasound (SPUS) for suspected appendicitis or gallstone disease to the “gold standard” of pathological examination or radiologist-performed ultrasound (RPUS). Data Sources MEDLINE, Embase, trial registries, conference proceedings, and article reference lists were searched to identify trials and/or studies comparing SPUS with pathology or RPUS as the reference standard. Data were abstracted from eligible studies to produce 2 × 2 contingency tables, permitting the calculation of pooled sensitivity and specificity values. Results Eight studies (1,268 patients) evaluated SPUS for appendicitis. For appendicitis, SPUS had a pooled sensitivity of .92 (95% confidence interval [CI], .887–.939) and a pooled specificity of .96 (95% CI, .946–.974). SPUS for gallstones was evaluated in 8 studies (1,019 patients). The pooled sensitivity was .96 (95% CI, .934–.979), and the specificity was .99 (95% CI .983–.998). Conclusions SPUS achieves acceptable sensitivity and specificity for both gallstones and appendicitis. However, there was some evidence of heterogeneity. Data regarding cost-effectiveness are lacking.