Surgical recommendations in Ehlers-Danlos syndrome(s) need patient classification: the example of Ehlers-Danlos syndrome hypermobility type (a.k.a. joint hypermobility syndrome)---reply.

In particular, EDS-HT is probably the most common EDS subtype [3] and likely represents one and the same disorder as the joint hypermobility syndrome (JHS) [4] . Therefore, it is reasonable that JHS/EDS-HT is the EDS form most frequently encountered in many surgery subspecialties, except perhaps in vascular and chest clinics. Not many data have been published concerning surgical aspects of JHS/EDS-HT. In contrast to vascular EDS in which surgery is typically associated with high risks, daily practice indicates that preventive contraindication to surgery is not a feature of JHS/EDS-HT. Nevertheless, a series of recently accumulated evidence and anecdotal reports depicts an extraordinarily complex pathophysiology of JHS/EDS-HT, which extends much beyond the involvement of the integumentary and musculoskeletal systems. Accordingly, many factors may influence the outcome of surgical and anesthetic procedures and should be considered during treatment planning. Table 1 summarizes available data and the ensuing recommendations in JHS/EDS-HT. I hope that this additional information will help to offer a more tailored surgical approach for patients affected by the JHS/EDSHT subtype. It is expected that future studies will improve our knowledge on the widespread consequences of JHS/EDS-HT, as well as other major EDS subtypes, in order to select more efficient and personalized management interventions.