Intraoperative ultrasound evaluation of the gallbladder was performed in 55 morbidly obese patients undergoing gastric bariatric surgery. Cholecystectomy was performed in the presence of any physical or ultrasonographic abnormality. Eighteen patients (33%) had cholecystectomy. Nine patients had palpable gallbladder disease confirmed by ultrasound. Nine patients had abnormalities detected by ultrasonography only. There was no false-negative ultrasonographic exam compared to physical exam. Pathologically, all specimens but one showed evidence of disease, thus there was a false-positive incidence of 1.8%. None of the 37 patients with normal physical and ultrasonographic examination have returned with gallbladder disease following the bariatric surgery. Intraoperative ultrasonography shows promise in detecting nonpalpable gallbladder disease and decreasing the incidence of delayed cholecystectomy.