The approach to the gallbladder at the time of laparoscopic gastric bypass varies from surgeon to surgeon, and a clear consensus does not exist. Options for those patients who still have their gallbladder at the time of gastric bypass (22% of UW laparoscopic gastric bypass patients have previously undergone cholecystectomy) include routine cholecystectomy in all patients, cholecystectomy if preoperative or intraoperative evaluation reveals gallstones, or no concurrent cholecystectomy except in unusual circumstances. There are advantages and disadvantages to each approach. In our program, we do not screen for gallstones preoperatively and instead visually inspect the gallbladder at the time of surgery. If there is obvious pathology, the gallbladder is removed at the time of laparoscopic gastric bypass. Otherwise, we typically place patients on ursodiol for 6 months following surgery to minimize the chances of new gallstones forming during the rapid weight loss phase.