In his first season in Serie B, Sannino led Varese to a remarkable fourth place and a spot in the promotion playoffs, but lost to Padova in the semi-finals.

[6] In the 2011–12 season, Sannino managed to keep Siena safely out of the relegation zone, and also led the club to the Coppa Italia semi-finals, then lost to eventual winners Napoli.

On 6 June 2012, Sannino signed a two-year contract as head coach of Palermo, only a few weeks after Siena director of football Giorgio Perinetti made the same move to Sicily.

[7] His short-lived experience with the Sicilians ended on 16 September 2012, when club chairman Maurizio Zamparini decided to remove him from first team duties after achieving only one point in the first three Serie A games; he was replaced by Gian Piero Gasperini.

[9] Despite an impressive string of results with a particularly difficult calendar (including wins against Inter and Roma), however, he failed to keep Palermo in the top flight.

[11] Despite winning four of the first five league games of the 2014–15 season, and with Watford second in the table, his future was subject to speculation following rumours of dressing-room unrest and some players disliking his management style.

[12] His period as Catania boss, however, lasted only three months, as he resigned on 19 December following a string a poor results and strained relationship with the club's board.

[14] On 3 November, it was announced that he had been relieved of his duties and he was replaced by Fabrizio Castori - the man he had initially replaced - as first team coach[15] He was subsequently appointed new head coach of Serie B club Salernitana for the 2016–17 season, but resigned from his position on 30 November 2016 after having criticised the attitude of the club's supporters following a league home draw to Pro Vercelli.

[16] Sannino then served as head coach of Triestina for the club's 2017–18 Serie C campaign, a job he left in February 2018 due to disagreements with the board, with his assistant Nicola Princivalli taking over from him.