Introduction The most prevalent cyanotic congenital cardiac condition is tetralogy of Fallot (TOF), which has a significant fatality rate in neonates who exhibit symptoms if treatment is not received. In this group, two surgical techniques are frequently employed: primary repair and staged repair. The best course of action is still up for dispute, though. The purpose of this study is to compare the clinical results of staged repair versus primary repair in order to assess the surgical strategy for symptomatic newborn TOF. Methods The PubMed, Cochrane, and ScienceDirect databases were searched for relevant material. Mortality, morbidity, duration of stay, and reintervention were among the postoperative outcomes evaluated. The Oxford Centre for Evidence-Based Medicine's recommendations were adhered to during the critical evaluation process. Results Seven studies were analyzed, and the results showed no discernible difference between staged and primary repair in terms of mortality or reintervention rates.  Nonetheless, staged repair was linked to more expensive and prolonged hospitalizations, whereas primary repair carried a greater risk of complications. Conclusion It has not been demonstrated that any surgical technique is consistently better across all clinical outcomes.  For high-risk newborns, such as those with low birth weight or pulmonary artery hypoplasia, staged repair seems more suitable. Individualized surgical decisions should take into account the anatomy of the patient, institutional knowledge, and the facilities that are available.